Provider Demographics
NPI:1568168615
Name:LEE, AMANDA RAINE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAINE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 NW CARY PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8431
Mailing Address - Country:US
Mailing Address - Phone:919-882-6100
Mailing Address - Fax:
Practice Address - Street 1:3701 NW CARY PKWY STE 305
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8431
Practice Address - Country:US
Practice Address - Phone:919-882-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist