Provider Demographics
NPI:1598942120
Name:MACON REHABILITATION & PERFORMANCE CENTER INC
Entity Type:Organization
Organization Name:MACON REHABILITATION & PERFORMANCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BONFIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:478-757-2255
Mailing Address - Street 1:125 PLANTATION CENTRE DR S
Mailing Address - Street 2:BLDG. 900
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2079
Mailing Address - Country:US
Mailing Address - Phone:478-757-2255
Mailing Address - Fax:478-477-2977
Practice Address - Street 1:125 PLANTATION CENTRE DR S
Practice Address - Street 2:BLDG. 900
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2079
Practice Address - Country:US
Practice Address - Phone:478-757-2255
Practice Address - Fax:478-477-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty