Healthcare Provider Details

I. General information

NPI: 1669506978
Provider Name (Legal Business Name): HUMAN PERFORMANCE CENTER 3 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 FLYNN ST
ALVA OK
73717-2240
US

IV. Provider business mailing address

PO BOX 26243
OKLAHOMA CITY OK
73126-0243
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-3331
  • Fax: 580-327-3314
Mailing address:
  • Phone: 580-327-3331
  • Fax: 580-327-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JERRAD HADA
Title or Position: PARTNER/THERAPIST
Credential:
Phone: 580-327-3331