Healthcare Provider Details

I. General information

NPI: 1407660608
Provider Name (Legal Business Name): ENDURANCE UNLEASHED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 STONE BRIDGE XING
CHAPEL HILL NC
27517-7016
US

IV. Provider business mailing address

47 STONE BRIDGE XING
CHAPEL HILL NC
27517-7016
US

V. Phone/Fax

Practice location:
  • Phone: 516-387-4669
  • Fax:
Mailing address:
  • Phone: 516-387-4669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT WILLIAM BERGHORN JR.
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT, ATC, USAW
Phone: 516-387-4669