Healthcare Provider Details

I. General information

NPI: 1740538057
Provider Name (Legal Business Name): BREAKTHROUGH PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 RAMSEY ST STE 111
FAYETTEVILLE NC
28311-7672
US

IV. Provider business mailing address

981 HIGH HOUSE RD STE 100
CARY NC
27513-3510
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-9300
  • Fax: 910-483-9302
Mailing address:
  • Phone: 919-388-0111
  • Fax: 919-388-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY W HATHAWAY
Title or Position: MAJORITY OWNER
Credential: PT, DPT
Phone: 315-458-2552