Provider Demographics
NPI:1508310392
Name:BREATHE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BREATHE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTRAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:308-293-3513
Mailing Address - Street 1:9608 COUNTY ROAD P17
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68002-5120
Mailing Address - Country:US
Mailing Address - Phone:402-378-0503
Mailing Address - Fax:
Practice Address - Street 1:13911 GOLD CIR
Practice Address - Street 2:STE 110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2378
Practice Address - Country:US
Practice Address - Phone:402-933-8383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2172003Medicare PIN