Breakaway Physical Therapy, LLC
NPI 1780077784ActiveOrganization· Physical Therapist· Crofton, MD
Physical Therapist in Crofton, Maryland, registered in NPPES in March 2015. The authorized official on file is Shaina Clemons, DPT, Owner. Enrolled in Medicare as part b supplier - physical/occupational therapy group in private practice.
Overview
| NPI | 1780077784 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 15, 2015 |
| Last updated in NPPES | Oct 26, 2020 |
| Certified by provider | Oct 26, 2020 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Physical/Occupational Therapy Group in Private Practice (MD) |
|---|
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