NPIMap

Organization Active NPI

Breakthrough SC LLC

  • Physical Therapy Clinic/Center
  • Fort Mill, SC
National Provider Identifier
1295219616
Registry record updated Sep 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
BREAKTHROUGH SC LLC
Practice address
7580 Charlotte Hwy Ste 1100
Fort Mill, SC 29707-7803
Phone
(803) 548-5662
Fax
(803) 548-5635
NPI assigned
Sep 21, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey Hathaway, DPT
Title
Ceo
Phone
(919) 388-0111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

7580 Charlotte Hwy Ste 1100
Fort Mill, SC 29707-7803

Mailing address

981 High House Rd Ste 100
Cary, NC 27513-3510
Phone (919) 377-8744

Other names 1

  • Your Life Wellness & Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181214000639 SC Part B Supplier - Clinic/Group Practice 1557606878 Receives reassigned benefits from 14 practitioners
Practice locations: Fort Lawn, SC; Fort Mill, SC
O20200323001373 NC Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1557606878 Receives reassigned benefits from 8 practitioners
Practice locations: Waxhaw, NC

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

981 High House Rd
#100
Cary, NC 27513
Phone (919) 388-0111

2514 Cuthbertson Rd
Ste D
Waxhaw, NC 28173
Phone (704) 810-4302

5554 Main St
Fort Lawn, SC 29714
Phone (803) 548-5662

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537488000000",
    "number": "1295219616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "981 HIGH HOUSE RD STE 100",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275133510",
            "telephone_number": "919-377-8744",
            "fax_number": "502-473-9310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7580 CHARLOTTE HWY STE 1100",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297077803",
            "telephone_number": "803-548-5662",
            "fax_number": "803-548-5635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKTHROUGH SC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-21",
        "last_updated": "2018-09-21",
        "status": "A",
        "authorized_official_last_name": "HATHAWAY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-388-0111",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Your Life Wellness & Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Mill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.