Provider Demographics
NPI:1750052973
Name:PHYSICAL THERAPY, ATHLETIC PERFORMANCE, & SPORTS REHABILITATION
Entity Type:Organization
Organization Name:PHYSICAL THERAPY, ATHLETIC PERFORMANCE, & SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO; PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:505-417-2542
Mailing Address - Street 1:9305 OAKLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3813
Mailing Address - Country:US
Mailing Address - Phone:505-417-2542
Mailing Address - Fax:
Practice Address - Street 1:7800 LAS LOMITAS NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1646
Practice Address - Country:US
Practice Address - Phone:505-417-2542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy