Provider Demographics
NPI:1639693641
Name:LEE, AMANDA LAUREN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LAUREN
Last Name:LEE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MOORESVILLE COMMONS WAY UNIT 320
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6105
Mailing Address - Country:US
Mailing Address - Phone:919-222-5825
Mailing Address - Fax:
Practice Address - Street 1:889 SHERWOOD LN
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4183
Practice Address - Country:US
Practice Address - Phone:704-881-0088
Practice Address - Fax:704-881-0087
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist