=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104782044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPIPHANY PELVIC HEALTH PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2026
-----------------------------------------------------
Last Update Date | 01/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 CAPCOM AVE STE 104
-----------------------------------------------------
City | WAKE FOREST
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27587-6537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-559-8450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3157 LANDING FALLS LN
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27616-8399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | DR. HAMEERA BROOKS
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 919-559-8450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------