Basic Information
Provider Information | |||||||||
NPI: | 1649688029 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BREAKTHROUGH PHYSICAL THERAPY INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
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NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
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OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
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OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1910 N CHURCH ST | ||||||||
Address2: | STE D | ||||||||
City: | GREENSBORO | ||||||||
State: | NC | ||||||||
PostalCode: | 274055666 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3362747480 | ||||||||
FaxNumber: | 3362748903 | ||||||||
Practice Location | |||||||||
Address1: | 1051 PEMBERTON HILL RD | ||||||||
Address2: | SUITE 201 | ||||||||
City: | APEX | ||||||||
State: | NC | ||||||||
PostalCode: | 275024267 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9193633640 | ||||||||
FaxNumber: | 9193633642 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/29/2014 | ||||||||
LastUpdateDate: | 11/30/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HATHAWAY | ||||||||
AuthorizedOfficialFirstName: | JEFFREY | ||||||||
AuthorizedOfficialMiddleName: | W | ||||||||
AuthorizedOfficialTitleorPosition: | PT, OWNER | ||||||||
AuthorizedOfficialTelephone: | 6072276366 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
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AuthorizedOfficialCredential: | PT, DPT | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   | 235Z00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   | 225100000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.