Basic Information
Provider Information
NPI: 1437279817
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANCHEZ
FirstName: ESTEBAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SANCHEZ
OtherFirstName: STEVE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: 2404 S LOCUST ST
Address2: SUITE 5
City: LAS CRUCES
State: NM
PostalCode: 880015789
CountryCode: US
TelephoneNumber: 5755214188
FaxNumber: 5755213668
Practice Location
Address1: 2404 S LOCUST ST
Address2: SUITE 5
City: LAS CRUCES
State: NM
PostalCode: 880015789
CountryCode: US
TelephoneNumber: 5755214188
FaxNumber: 5755213668
Other Information
ProviderEnumerationDate: 03/30/2007
LastUpdateDate: 02/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X1150691TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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