Provider Demographics
NPI:1023534682
Name:LEGGETT, SEAN JAMES (ATC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:JAMES
Last Name:LEGGETT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BRIGANTINE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-1154
Mailing Address - Country:US
Mailing Address - Phone:518-810-7675
Mailing Address - Fax:
Practice Address - Street 1:962 LUTHER RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-4015
Practice Address - Country:US
Practice Address - Phone:518-207-2084
Practice Address - Fax:518-207-2089
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002501-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer