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General NPI Number Information
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NPI Number | 1134490337
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Entity Type | Organization
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Legal Business Name | UPLIFTED LLC
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 3900 BARRETT DR SUITE 208
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City | RALEIGH
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State | NC
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Zip | 27609-6641
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Country | US
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Telephone | 919-803-8985
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Fax |
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Provider Business Mailing Address
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Address Line | 6905 SANDRINGHAM DR
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City | RALEIGH
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State | NC
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Zip | 27613-4052
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Country | US
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Telephone | 919-622-6068
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMANDA C TOMMERSON
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Credential | CFM
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Telephone | 919-622-6068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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