Provider Demographics
NPI:1689153793
Name:HUMAN FUNCTION AND PERFORMANCE, LLC
Entity Type:Organization
Organization Name:HUMAN FUNCTION AND PERFORMANCE, LLC
Other - Org Name:JOHN EARLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:802-505-5013
Mailing Address - Street 1:1408 N RIVERFRONT BLVD # 211
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3912
Mailing Address - Country:US
Mailing Address - Phone:469-626-7254
Mailing Address - Fax:214-237-1283
Practice Address - Street 1:136 GLASS ST # 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-6910
Practice Address - Country:US
Practice Address - Phone:469-626-7254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy