Provider Demographics
NPI:1295383594
Name:BREAKTHROUGH PEDIATRICS LLC
Entity type:Organization
Organization Name:BREAKTHROUGH PEDIATRICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-957-5494
Mailing Address - Street 1:13710 E RICE PL STE 240
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1074
Mailing Address - Country:US
Mailing Address - Phone:720-547-0885
Mailing Address - Fax:720-698-4070
Practice Address - Street 1:13710 E RICE PL STE 240
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1074
Practice Address - Country:US
Practice Address - Phone:720-547-0885
Practice Address - Fax:720-698-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2024-11-25
Deactivation Date:2021-07-27
Deactivation Code:
Reactivation Date:2021-08-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty