Provider Demographics
NPI:1508620808
Name:HUMAN PERFORMANCE AND REHABILITATION CENTERS LLC
Entity Type:Organization
Organization Name:HUMAN PERFORMANCE AND REHABILITATION CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DONOVAN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:706-320-5463
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:757-208-4731
Mailing Address - Fax:812-590-8333
Practice Address - Street 1:1157B WEST AVE SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5280
Practice Address - Country:US
Practice Address - Phone:770-922-2420
Practice Address - Fax:770-922-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies