Healthcare Provider Details

I. General information

NPI: 1144893660
Provider Name (Legal Business Name): HUMAN PERFORMANCE AND REHABILITATION CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HIGHWAY 34 E
NEWNAN GA
30265-6803
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 770-290-8002
  • Fax: 770-783-8026
Mailing address:
  • Phone: 706-324-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK DONOVAN GRAHAM
Title or Position: CEO
Credential:
Phone: 706-320-5463