Provider Demographics
NPI:1053022756
Name:BREAKTHROUGH THERAPY CENTER, LLC
Entity type:Organization
Organization Name:BREAKTHROUGH THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-707-7530
Mailing Address - Street 1:2001 KILLEBREW DR STE 112
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1871
Mailing Address - Country:US
Mailing Address - Phone:952-212-0358
Mailing Address - Fax:612-326-6160
Practice Address - Street 1:2720 SUPERIOR DR NW STE 101
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1775
Practice Address - Country:US
Practice Address - Phone:952-212-0358
Practice Address - Fax:612-326-6160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency