Healthcare Provider Details

I. General information

NPI: 1578863858
Provider Name (Legal Business Name): BREAKTHROUGH WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20-22 THOREAU DR
FREEHOLD NJ
07728-4329
US

IV. Provider business mailing address

20-22 THOREAU DR
FREEHOLD NJ
07728-4329
US

V. Phone/Fax

Practice location:
  • Phone: 732-303-1425
  • Fax: 732-780-7990
Mailing address:
  • Phone: 732-303-1425
  • Fax: 732-780-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL FAILLA
Title or Position: PARTNER
Credential: DC
Phone: 732-303-1425