Healthcare Provider Details

I. General information

NPI: 1679616510
Provider Name (Legal Business Name): BREAKING GROUND LANDSCAPE DESIGN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10053 NW 47TH ST
CORAL SPRINGS FL
33076-2495
US

IV. Provider business mailing address

10053 NW 47TH ST
CORAL SPRINGS FL
33076-2495
US

V. Phone/Fax

Practice location:
  • Phone: 954-344-0733
  • Fax: 954-341-8669
Mailing address:
  • Phone: 954-344-0733
  • Fax: 954-341-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY THOMAS MORAN
Title or Position: OWNER, CEO
Credential: EDD
Phone: 954-344-0733