Provider Demographics
NPI:1417029513
Name:HUMAN PERFORMANCE AND REHABILITATION CENTERS, INC.
Entity Type:Organization
Organization Name:HUMAN PERFORMANCE AND REHABILITATION CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCLUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-322-7762
Mailing Address - Street 1:PO BOX 8068
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8068
Mailing Address - Country:US
Mailing Address - Phone:803-253-6721
Mailing Address - Fax:803-799-8177
Practice Address - Street 1:1910 BLANDING ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3520
Practice Address - Country:US
Practice Address - Phone:803-253-6721
Practice Address - Fax:803-799-8177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMAN PERFORMANCE AND REHABILITATION CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC225100000X, 225X00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1100Medicaid
SCGP1100Medicaid
SC6945Medicare PIN