Healthcare Provider Details

I. General information

NPI: 1750109807
Provider Name (Legal Business Name): FRKATHLETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 S IVY WAY APT B1
CENTENNIAL CO
80112-6235
US

IV. Provider business mailing address

6701 S IVY WAY APT B1
CENTENNIAL CO
80112-6235
US

V. Phone/Fax

Practice location:
  • Phone: 720-243-8863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name: FRANK ALEJANDRO OVALLES
Title or Position: ATHLETIC TRAINER
Credential: ATC
Phone: 720-243-8863