Provider Demographics
NPI:1013057322
Name:OMNI HUMAN PERFORMANCE CONSULTING
Entity Type:Organization
Organization Name:OMNI HUMAN PERFORMANCE CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:262-886-2599
Mailing Address - Street 1:1611 RENAISSANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-1741
Mailing Address - Country:US
Mailing Address - Phone:262-886-2599
Mailing Address - Fax:
Practice Address - Street 1:1611 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1741
Practice Address - Country:US
Practice Address - Phone:262-886-2599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI85145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty