Provider Demographics
NPI:1629618723
Name:BREAKINGTHROUGH SAN DIEGO PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BREAKINGTHROUGH SAN DIEGO PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:551-574-7459
Mailing Address - Street 1:2424 VISTA WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6178
Mailing Address - Country:US
Mailing Address - Phone:551-574-7459
Mailing Address - Fax:
Practice Address - Street 1:2424 VISTA WAY STE 120
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6178
Practice Address - Country:US
Practice Address - Phone:551-574-7459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty