Healthcare Provider Details

I. General information

NPI: 1346478948
Provider Name (Legal Business Name): AMY H PANNULLO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 PEMBERTON HILL RD STE 102
APEX NC
27502-4267
US

IV. Provider business mailing address

1051 PEMBERTON HILL RD STE 102
APEX NC
27502-4267
US

V. Phone/Fax

Practice location:
  • Phone: 919-335-5837
  • Fax: 919-404-7630
Mailing address:
  • Phone: 919-335-5837
  • Fax: 919-404-7630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10818
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: