Healthcare Provider Details

I. General information

NPI: 1750052973
Provider Name (Legal Business Name): PHYSICAL THERAPY, ATHLETIC PERFORMANCE, & SPORTS REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 LAS LOMITAS NE STE C
ALBUQUERQUE NM
87113-1646
US

IV. Provider business mailing address

9305 OAKLAND AVE NE
ALBUQUERQUE NM
87122-3813
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-2542
  • Fax:
Mailing address:
  • Phone: 505-417-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY C CHAVEZ
Title or Position: OWNER/CEO; PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 505-417-2542