Provider Demographics
NPI:1871623397
Name:HUMAN PERFORMANCE CENTER 2 PLLC
Entity type:Organization
Organization Name:HUMAN PERFORMANCE CENTER 2 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-946-7300
Mailing Address - Street 1:3327 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5627
Mailing Address - Country:US
Mailing Address - Phone:405-946-7300
Mailing Address - Fax:405-946-7306
Practice Address - Street 1:3327 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5627
Practice Address - Country:US
Practice Address - Phone:405-946-7300
Practice Address - Fax:405-946-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522048Medicare ID - Type Unspecified