Provider Demographics
NPI:1295373181
Name:RABIN, AMANDA MORCOM (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MORCOM
Last Name:RABIN
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MERCEDES
Other - Last Name:MORCOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1991 FORDHAM DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3774
Mailing Address - Country:US
Mailing Address - Phone:910-484-4653
Mailing Address - Fax:910-483-9256
Practice Address - Street 1:1991 FORDHAM DR STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3774
Practice Address - Country:US
Practice Address - Phone:910-484-4653
Practice Address - Fax:910-483-9256
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60983464225100000X
NCP20068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist