Provider Demographics
NPI:1417205147
Name:HANDS ON PERFORMANCE LLC
Entity Type:Organization
Organization Name:HANDS ON PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-342-4612
Mailing Address - Street 1:1430 SW SAINT LUCIE WEST BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2134
Mailing Address - Country:US
Mailing Address - Phone:772-785-8500
Mailing Address - Fax:
Practice Address - Street 1:1430 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2134
Practice Address - Country:US
Practice Address - Phone:772-785-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service