Provider Demographics
NPI:1851483382
Name:BREAKTHROUGH REHAB, INC.
Entity Type:Organization
Organization Name:BREAKTHROUGH REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:TADA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-753-7617
Mailing Address - Street 1:3465 WAIALAE AVENUE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-753-7617
Mailing Address - Fax:808-735-3556
Practice Address - Street 1:3465 WAIALAE AVENUE
Practice Address - Street 2:SUITE 240
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-753-7617
Practice Address - Fax:808-735-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI=========OtherTRICARE
HI=========OtherHMAA
HI53492Medicare ID - Type Unspecified
X61034Medicare UPIN