Provider Demographics
NPI:1407660608
Name:ENDURANCE UNLEASHED, LLC
Entity type:Organization
Organization Name:ENDURANCE UNLEASHED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BERGHORN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT, ATC, USAW
Authorized Official - Phone:516-387-4669
Mailing Address - Street 1:47 STONE BRIDGE XING
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7016
Mailing Address - Country:US
Mailing Address - Phone:516-387-4669
Mailing Address - Fax:
Practice Address - Street 1:47 STONE BRIDGE XING
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7016
Practice Address - Country:US
Practice Address - Phone:516-387-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)