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General NPI Number Information
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NPI Number | 1720649510
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Entity Type | Individual
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Provider Name | ROSS CLIFTON FAVER MS, ATC/L, CEAS
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Gender | Male
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 18411 22ND DR SE
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City | BOTHELL
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State | WA
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Zip | 98012-6972
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Country | US
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Telephone | 602-909-7185
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Fax |
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Provider Business Mailing Address
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Address Line | 18411 22ND DR SE
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City | BOTHELL
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State | WA
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Zip | 98012-6972
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Country | US
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Telephone | 602-909-7185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A160215545
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License Number State | WA
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