Organization
BREAKAWAY PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAINA CLEMONS DPT (OWNER)
(410) 721-6333
Entity
Organization
Contact information
Practice address
2138 PRIEST BRIDGE CT STE 7, CROFTON, MD 21114-2463
(410) 721-6333
(410) 721-7651
Mailing address
PO BOX 4704, CROFTON, MD 21114-4704
(410) 721-6333
(410) 721-7651
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
03/15/2015
Last updated
10/26/2020
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