Breakthrough SC LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

BREAKTHROUGH SC LLC

Doing business as

Your Life Wellness & Physical Therapy

Practice address

2514 Cuthbertson Rd Ste D
Waxhaw, NC 28173-6417

Phone

(704) 810-4302

Fax

(704) 705-4588

NPI assigned

Mar 18, 2020

Last updated

Mar 18, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey W HathawayNPI 1518930809

Title

Ceo

Phone

(315) 458-2552

Specialties & licenses 1

Addresses

Other names 1

• Your Life Wellness & Physical Therapy Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jeffrey W Hathaway, PT, DPT

  • Physical Therapist
  • North Syracuse, NY
  • NPI 1518930809
  Authorized official Same address or phone
• Matthew B Ware, PT

  • Physical Therapist
  • Cary, NC
  • NPI 1598933210
  NPD

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

{
    "created_epoch": "1584489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584489600000",
    "number": "1952937328",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2514 CUTHBERTSON RD STE D",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736417",
            "telephone_number": "704-810-4302",
            "fax_number": "704-705-4588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAKTHROUGH SC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-18",
        "last_updated": "2020-03-18",
        "certification_date": "2020-03-18",
        "status": "A",
        "authorized_official_last_name": "HATHAWAY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "315-458-2552"
    },
    "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"
        }
    ]
}

• Eden Bozza, LCSW
• Sean Michael Bradley, M.D.
• Andrew Jackson Branch, DDS
• Amanda Cummings Brandenburg, PH.D.
• Gina Brannagan
• Kelley Klaswick Brewer
• Brothers Care Group Homes LLC
• Abigail Valenta Brown, OTD, OTR/L
• Ethan Gabriel Brown, PTA
• Building Blocks

• Physical Therapy Clinic/Center in Waxhaw, NC
• Providers in Waxhaw, NC by specialty
• Physical Therapy Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.