Healthcare Provider Details

I. General information

NPI: 1053508671
Provider Name (Legal Business Name): HUMAN PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 AQUARIUS AVE
SILVER SPRING MD
20906-1813
US

IV. Provider business mailing address

2906 AQUARIUS AVE
SILVER SPRING MD
20906-1813
US

V. Phone/Fax

Practice location:
  • Phone: 240-277-4427
  • Fax:
Mailing address:
  • Phone: 240-277-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1926
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number862
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15251
License Number StateMD

VIII. Authorized Official

Name: DR. DONNA TOBY KIMMEL
Title or Position: PRESIDENT
Credential: PHD
Phone: 240-277-4427