Provider Demographics
NPI:1053478826
Name:HUMAN PERFORMANCE INSTITUTE PC
Entity Type:Organization
Organization Name:HUMAN PERFORMANCE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-756-7777
Mailing Address - Street 1:1184 E 80 N
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2906
Mailing Address - Country:US
Mailing Address - Phone:801-756-7777
Mailing Address - Fax:
Practice Address - Street 1:1184 E 80 N
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2906
Practice Address - Country:US
Practice Address - Phone:801-756-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT119421-2401261QP2000X
UT120093-2401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005722602Medicare ID - Type UnspecifiedRUSSELL J GATENBY
UT005722601Medicare ID - Type UnspecifiedJOHN ROBERT SUMSION
UT000057226Medicare ID - Type UnspecifiedHUMAN PERFORMANCE