Healthcare Provider Details

I. General information

NPI: 1386258143
Provider Name (Legal Business Name): BREAKTHROUGH THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 AMERICAN BLVD E STE 19
BLOOMINGTON MN
55425-1401
US

IV. Provider business mailing address

2001 KILLEBREW DR STE 112
BLOOMINGTON MN
55425-1871
US

V. Phone/Fax

Practice location:
  • Phone: 952-212-0358
  • Fax: 612-326-6160
Mailing address:
  • Phone: 952-212-0358
  • Fax: 612-326-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HAMID AHMED MOHAMED
Title or Position: CO-FOUNDER, CEO
Credential:
Phone: 612-707-7530