Healthcare Provider Details

I. General information

NPI: 1619926813
Provider Name (Legal Business Name): CHARLES LAWSON LIGGETT MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

PO BOX 5371 MS MB.10.620
SEATTLE WA
98145
US

V. Phone/Fax

Practice location:
  • Phone: 253-670-2425
  • Fax:
Mailing address:
  • Phone: 206-987-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA1 60037027
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: