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General NPI Number Information
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NPI Number | 1750052973
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY, ATHLETIC PERFORMANCE, & SPORTS REHABILITATION
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 7800 LAS LOMITAS NE STE C
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1646
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Country | US
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Telephone | 505-417-2542
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Fax |
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Provider Business Mailing Address
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Address Line | 9305 OAKLAND AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3813
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Country | US
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Telephone | 505-417-2542
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO; PHYSICAL THERAPIST
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Name | DR. ANTHONY C CHAVEZ
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Credential | PT, DPT
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Telephone | 505-417-2542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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