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NPI Code Detail

MEDICARE: BREAKTHROUGH THERAPY CENTER, LLC

MEDICARE: BREAKTHROUGH THERAPY CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1252Y00000XEarly Intervention Provider Agency

General Provider Information

NPI Number : 1053022756
Entity Type Code : Organization
Provider Name (Legal Business Name) : BREAKTHROUGH THERAPY CENTER, LLC
Provider Business Mailing Address
First Line : 2001 KILLEBREW DR STE 112
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-1871
Country : US
Telephone Number : 952-212-0358
Fax Number : 612-326-6160
Provider Business Practice Location Address
First Line : 2720 SUPERIOR DR NW STE 101
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-1775
Country : US
Telephone Number : 952-212-0358
Fax Number : 612-326-6160
Authorized Official
Title or Position : CEO/PRESIDENT
Name : HAMID AHMED MOHAMED
Credential :
Telephone Number : 612-707-7530
Provider Enumeration Date : 12/13/2022
Last Update Date : 06/04/2024

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