1356491146 NPI number — PARADIGM PHYSICAL THERAPY AND WELLNESS INC

Table of content: (NPI 1356491146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356491146 NPI number — PARADIGM PHYSICAL THERAPY AND WELLNESS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARADIGM PHYSICAL THERAPY AND WELLNESS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LOS LUNAS PHYSICAL THERAPY INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356491146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 HIGHWAY 314 SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS LUNAS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87031-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-866-0055
Provider Business Mailing Address Fax Number:
505-866-0057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 CAMINO DEL LLANO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELEN
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87002-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-866-0055
Provider Business Practice Location Address Fax Number:
505-866-0057
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PRES/OWNER
Authorized Official Telephone Number:
505-866-0055

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  593 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X , with the licence number: 2251 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000Q0406 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013214857 . This is a "VALERIE GUTIERREZ, DPT" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1326062423 . This is a "STEVE WAGHORN, PT" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1417971508 . This is a "DONALD SANCHEZ' NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1215238910 . This is a "PATRICK VIGIL, DPT" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1386651412 . This is a "LOS LUNAS FACILITY NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: DC4165 . This is a "GROUP RR MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1245380039 . This is a "BERNALILLO FACILITY NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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