Provider Demographics
NPI:1740646454
Name:BREAKOUT ADVISORS AND REHABILITATION LLC
Entity type:Organization
Organization Name:BREAKOUT ADVISORS AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:O
Authorized Official - Last Name:LEMCKE
Authorized Official - Suffix:
Authorized Official - Credentials:ATC,PT,OCS
Authorized Official - Phone:724-934-6813
Mailing Address - Street 1:10 N MEADOWS DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8367
Mailing Address - Country:US
Mailing Address - Phone:724-934-6813
Mailing Address - Fax:724-934-1841
Practice Address - Street 1:10 N MEADOWS DR
Practice Address - Street 2:SUITE 10
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8367
Practice Address - Country:US
Practice Address - Phone:724-934-6813
Practice Address - Fax:724-934-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty