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General NPI Number Information
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NPI Number | 1386258143
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH THERAPY CENTER, LLC
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1701 AMERICAN BLVD E STE 19
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1401
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Country | US
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Telephone | 952-212-0358
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Fax | 612-326-6160
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Provider Business Mailing Address
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Address Line | 2001 KILLEBREW DR STE 112
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1871
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Country | US
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Telephone | 952-212-0358
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Fax | 612-326-6160
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Authorized Official
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Title or Position | CO-FOUNDER, CEO
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Name | MR. HAMID AHMED MOHAMED
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Credential |
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Telephone | 612-707-7530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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