Jon Michael Breakey, PT DPT
Individual provider Active NPI Physical Therapist · Hampstead, MD
NPI 1720162100 · NPPES record last updated Dec 2, 2011
Key facts
- NPI
- 1720162100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 15423 (MD)
- Practice address
- 1801 Hanover Pike
Hampstead, MD 21074 - Phone
- (410) 239-2408
- Fax
- (410) 239-2293
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT015802 | PA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 15423 | MD | Yes |
| Physical Therapist | 225100000X | PT015802 | PA |
Addresses
Primary practice location
1801 Hanover Pike
Hampstead, MD 21074
Mailing address
1801 Hanover Pike
Hampstead, MD 21074
Phone (410) 239-2408
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35086101 | Other | MD | BLUE CROSS BLUE SHIELD |
| R6390001 | Other | MD | FEDERAL BLUE CROSS |
| 321811 | Other | MD | MAMSI |
Other providers in Hampstead, MD
- Molly Ramsey Bettridge
- Greg Mark Booth
- Maria Mikaela Vicerra Borja
- Kristian Brady
- Drew Michael Breakey
- Bridginglife, Inc
- Bridginglife, Inc
- Bridginglife, Inc
- Anthony Brocato Jr.
- Stacie Lynn Butler
All providers in Hampstead, MD · Physical Therapist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.