Provider Demographics
NPI:1922477728
Name:SANCHEZ, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 N MAIN ST
Mailing Address - Street 2:UNIT 18
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2412
Mailing Address - Country:US
Mailing Address - Phone:970-641-3298
Mailing Address - Fax:970-641-7369
Practice Address - Street 1:718 N MAIN ST
Practice Address - Street 2:UNIT 18
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2412
Practice Address - Country:US
Practice Address - Phone:970-641-3298
Practice Address - Fax:970-641-7369
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0013455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist