MEDICARE: WAKE FOREST PERFORMANCE AND REHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1417898180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKE FOREST PERFORMANCE AND REHAB

Provider Business Mailing Address
First Line	:	533 YOUNG FOREST DR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-7176
Country	:	US
Telephone Number	:	561-951-5203
Fax Number	:

Provider Business Practice Location Address
First Line	:	533 YOUNG FOREST DR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-7176
Country	:	US
Telephone Number	:	561-951-5203
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WAYNE CARNEY
Credential	:	PT, DPT, CSCS
Telephone Number	:	561-951-5203

Provider Enumeration Date	:	04/04/2026
Last Update Date	:	04/04/2026

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