Healthcare Provider Details

I. General information

NPI: 1780596098
Provider Name (Legal Business Name): FPGYM PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 S 132ND ST
OMAHA NE
68144-2501
US

IV. Provider business mailing address

1714 CANTERBURY RD
RALEIGH NC
27608-1110
US

V. Phone/Fax

Practice location:
  • Phone: 855-749-7461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARC DOUEK
Title or Position: MANAGING PARTNER
Credential:
Phone: 919-327-7697