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General NPI Number Information
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NPI Number | 1821406331
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Entity Type | Individual
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Provider Name | AARON MATTHEW LIBOLT PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 4011 TALBOT RD S STE 300
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City | RENTON
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State | WA
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Zip | 98055-5791
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Country | US
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Telephone | 425-656-5060
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Fax | 425-656-5047
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Provider Business Mailing Address
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Address Line | 4011 TALBOT RD S STE 300
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City | RENTON
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State | WA
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Zip | 98055-5791
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Country | US
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Telephone | 425-656-5060
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Fax | 425-656-5047
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA61223537
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License Number State | WA
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