Healthcare Provider Details

I. General information

NPI: 1144159294
Provider Name (Legal Business Name): BREAKTHROUGH PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7154 HWY 45 N
NETTLETON MS
38821
US

IV. Provider business mailing address

60368 COTTON GIN PORT RD
AMORY MS
38821-9104
US

V. Phone/Fax

Practice location:
  • Phone: 662-591-1077
  • Fax: 662-591-1024
Mailing address:
  • Phone: 662-257-3669
  • Fax: 662-257-3961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY JAMES RANDOLPH
Title or Position: OWNER
Credential: DPT
Phone: 662-315-6583