Healthcare Provider Details

I. General information

NPI: 1225964646
Provider Name (Legal Business Name): KATHERINE MELINA EI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

835 WAKE FOREST BUSINESS PARK STE A
WAKE FOREST NC
27587-7324
US

IV. Provider business mailing address

4201 LAKE BOONE TRL STE 4
RALEIGH NC
27607-7511
US

V. Phone/Fax

Practice location:
  • Phone: 919-562-9941
  • Fax:
Mailing address:
  • Phone: 919-781-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP24977
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: