Provider Demographics
NPI:1821650367
Name:PEAK PELVIC HEALTH PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PEAK PELVIC HEALTH PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNULLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MA, WCS,CLT
Authorized Official - Phone:516-361-3252
Mailing Address - Street 1:5517 MONARCH BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-5747
Mailing Address - Country:US
Mailing Address - Phone:516-361-3252
Mailing Address - Fax:
Practice Address - Street 1:160 MACGREGOR PINES DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6037
Practice Address - Country:US
Practice Address - Phone:919-335-5837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty