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General NPI Number Information
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NPI Number | 1710349220
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Entity Type | Organization
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Legal Business Name | EVOLV STRONG, LLC
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 3201 CANDELARIA RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107
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Country | US
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Telephone | 505-872-3408
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 CANDELARIA RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-1906
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Country | US
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Telephone | 505-872-3408
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CURT JASON CHAVEZ
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Credential | AT,MBA
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Telephone | 505-872-3408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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