Provider Demographics
NPI:1407193931
Name:MOONEY, AMANDA CARMELA (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CARMELA
Last Name:MOONEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ALTIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10560 LIGON MILL ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-556-4678
Mailing Address - Fax:919-556-4619
Practice Address - Street 1:10560 LIGON MILL ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-556-4678
Practice Address - Fax:919-556-4619
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035277-1225100000X
NC17447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist