Provider Demographics
NPI:1144893660
Name:HUMAN PERFORMANCE AND REHABILITATION CENTERS LLC
Entity type:Organization
Organization Name:HUMAN PERFORMANCE AND REHABILITATION CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DONOVAN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-320-5463
Mailing Address - Street 1:6298 VETERANS PKWY STE 5A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6245
Mailing Address - Country:US
Mailing Address - Phone:706-324-3667
Mailing Address - Fax:
Practice Address - Street 1:1025 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6803
Practice Address - Country:US
Practice Address - Phone:770-290-8002
Practice Address - Fax:770-783-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty