Individual
AMANDA MONTABAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3000 S CROATAN HWY, NAGS HEAD, NC 27959-9029
(252) 441-3507
(252) 441-1327
Mailing address
5200 N CROATAN HWY, KITTY HAWK, NC 27949-3990
(252) 261-9211
(252) 261-4329
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
8089
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079JX
BCBSNC
NC
05
—
7211718
—
NC
01
—
D4924
MEDCOST
NC
Enumeration date
01/26/2006
Last updated
07/08/2007
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