Healthcare Provider Details

I. General information

NPI: 1104415983
Provider Name (Legal Business Name): HUMAN PERFORMANCE AND REHABILITATION CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6298 VETERANS PKWY STE 5A
COLUMBUS GA
31909-6245
US

IV. Provider business mailing address

PO BOX 8068
COLUMBUS GA
31908-8068
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-7762
  • Fax: 706-327-6157
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MCCLUSKEY
Title or Position: CEO/MEMBER
Credential:
Phone: 706-322-7762