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NPI Code Detail

MEDICARE: BREAKTHROUGH BARRIERS LLC

MEDICARE: BREAKTHROUGH BARRIERS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106E00000XAssistant Behavior Analyst
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1164055299
Entity Type Code : Organization
Provider Name (Legal Business Name) : BREAKTHROUGH BARRIERS LLC
Provider Business Mailing Address
First Line : 1969 S ALAFAYA TRL # 346
Second Line :
City : ORLANDO
State : FL
Zip : 32828-8732
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 958 EARLY AVE
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-1756
Country : US
Telephone Number : 678-431-4279
Fax Number :
Authorized Official
Title or Position : CEO
Name : CATHERINE IVEY
Credential :
Telephone Number : 678-431-4279
Provider Enumeration Date : 02/18/2020
Last Update Date : 02/18/2020

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Directions to “BREAKTHROUGH BARRIERS LLC ” Practice Location

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