Provider Demographics
NPI:1134490337
Name:UPLIFTED LLC
Entity Type:Organization
Organization Name:UPLIFTED LLC
Other - Org Name:UPLIFTED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:TOMMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:919-622-6068
Mailing Address - Street 1:6905 SANDRINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4052
Mailing Address - Country:US
Mailing Address - Phone:919-622-6068
Mailing Address - Fax:
Practice Address - Street 1:3900 BARRETT DR
Practice Address - Street 2:SUITE 208
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6641
Practice Address - Country:US
Practice Address - Phone:919-803-8985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier