MEDICARE: PHYSICAL THERAPY, ATHLETIC PERFORMANCE, & SPORTS REHABILITATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

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

Provider Business Mailing Address
First Line	:	9305 OAKLAND AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-3813
Country	:	US
Telephone Number	:	505-417-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 LAS LOMITAS NE STE C
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1646
Country	:	US
Telephone Number	:	505-417-2542
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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