1891583654 NPI number — HUMAN PERFORMANCE AND REHABILITATION CENTERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891583654 NPI number — HUMAN PERFORMANCE AND REHABILITATION CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMAN PERFORMANCE AND REHABILITATION CENTERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891583654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 LYNDON FARM CT STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
812-590-8333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6298 VETERANS PKWY STE 5B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31909-6244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-225-0380
Provider Business Practice Location Address Fax Number:
706-225-0390
Provider Enumeration Date:
04/30/2025

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
DONOVAN
Authorized Official Title or Position:
CO-CEO/PARTNER
Authorized Official Telephone Number:
706-320-5463

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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