Provider Demographics
NPI:1689878217
Name:DORIA, AMEDA
Entity Type:Individual
Prefix:
First Name:AMEDA
Middle Name:
Last Name:DORIA
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 1:5157 HOLLY RIDGE FARM RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6105
Mailing Address - Country:US
Mailing Address - Phone:919-790-8636
Mailing Address - Fax:
Practice Address - Street 1:5157 HOLLY RIDGE FARM RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6105
Practice Address - Country:US
Practice Address - Phone:919-790-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11324225100000X
NJ40QA0118500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist