Provider Demographics
NPI:1669573945
Name:BAKER, AMANDA NILES (MPT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NILES
Last Name:BAKER
Suffix:
Gender:F
Credentials:MPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 HEALTH PARK
Mailing Address - Street 2:SUITE 127
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4730
Mailing Address - Country:US
Mailing Address - Phone:919-845-6160
Mailing Address - Fax:919-845-6188
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:SUITE 127
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4730
Practice Address - Country:US
Practice Address - Phone:919-845-6160
Practice Address - Fax:919-845-6188
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102612251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBCBS- 06709OtherBCBS