Healthcare Provider Details

I. General information

NPI: 1144109885
Provider Name (Legal Business Name): BRIDGE THE GAP PHYSICAL THERAPY AND PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CONOVER STA SE
CONOVER NC
28613-1940
US

IV. Provider business mailing address

4030 WAKE FOREST RD
RALEIGH NC
27609-0010
US

V. Phone/Fax

Practice location:
  • Phone: 980-350-1319
  • Fax: 704-803-9270
Mailing address:
  • Phone: 980-350-1319
  • Fax: 704-803-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID BARNA
Title or Position: OWNER
Credential: PT
Phone: 980-350-1319