Individual
MR. JON MICHAEL BREAKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT DPT
Contact information
Practice address
1801 HANOVER PIKE, HAMPSTEAD, MD 21074
(410) 239-2408
(410) 239-2293
Mailing address
1801 HANOVER PIKE, HAMPSTEAD, MD 21074
(410) 239-2408
(410) 239-2293
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15423
MD
225100000X
Physical Therapist
PT015802
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
321811
MAMSI
MD
01
—
35086101
BLUE CROSS BLUE SHIELD
MD
01
—
R6390001
FEDERAL BLUE CROSS
MD
Enumeration date
10/24/2006
Last updated
12/02/2011
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