Provider Demographics
NPI:1386256543
Name:MARCIC, AMANDA LOGAN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOGAN
Last Name:MARCIC
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FOX DEN CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9100
Mailing Address - Country:US
Mailing Address - Phone:614-519-2024
Mailing Address - Fax:
Practice Address - Street 1:110 CANAL ST STE 3
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4589
Practice Address - Country:US
Practice Address - Phone:888-855-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCP035261T225100000X
NCP23013225100000X
FLPT36121225100000X
TNCP037185T225100000X
NHCP035282T225100000X
NJCP035281T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist