MEDICARE: HUMAN PERFORMANCE AND REHABILITATION CENTERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1992394779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMAN PERFORMANCE AND REHABILITATION CENTERS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 8068
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31908-8068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4114 FOREST DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4316
Country	:	US
Telephone Number	:	803-939-2213
Fax Number	:	803-939-2214

Authorized Official
Title or Position	:	CEO/MEMBER
Name	:	BRIAN MCCLUSKEY
Credential	:
Telephone Number	:	706-322-7762

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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