Healthcare Provider Details

I. General information

NPI: 1437223666
Provider Name (Legal Business Name): HUMAN PERFORMANCE AND REHABILITATION CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6298 VETERANS PKWY SUITE 5A
COLUMBUS GA
31909-6258
US

IV. Provider business mailing address

PO BOX 8068
COLUMBUS GA
31908-8068
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-3667
  • Fax: 706-324-4609
Mailing address:
  • Phone: 706-324-3667
  • Fax: 706-324-4609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. BRIAN S MCCLUSKEY
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 706-322-7762