Healthcare Provider Details

I. General information

NPI: 1679130504
Provider Name (Legal Business Name): TAYLOR NICOLE CHAVEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2019
Last Update Date: 05/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 HORIZON BLVD NE
ALBUQUERQUE NM
87113-1689
US

IV. Provider business mailing address

5943 KIM RD NE
RIO RANCHO NM
87144-1548
US

V. Phone/Fax

Practice location:
  • Phone: 508-808-9204
  • Fax:
Mailing address:
  • Phone: 508-808-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: