Provider Demographics
NPI:1609813989
Name:HUMAN PERFORMANCE AND REHABILITATION CENTERS, INC.
Entity Type:Organization
Organization Name:HUMAN PERFORMANCE AND REHABILITATION CENTERS, INC.
Other - Org Name:HPRC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MC CLUSKEY
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:706-320-5461
Mailing Address - Fax:
Practice Address - Street 1:6298 VETERANS PKWY
Practice Address - Street 2:SUITE 5A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3526
Practice Address - Country:US
Practice Address - Phone:706-324-3558
Practice Address - Fax:706-320-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X
GA2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300023633BMedicaid
AL529602320Medicaid
SCGP1100Medicaid
ALK457Medicare PIN
ALJ101Medicare PIN
ALK261Medicare PIN
AL529602320Medicaid
ALI710Medicare PIN
SC6945Medicare PIN