Provider Demographics
NPI:1104890037
Name:CHARLES-LISCOMBE, ROBERT S (ATC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:S
Last Name:CHARLES-LISCOMBE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:6702 POPLAR GROVE TRL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8629
Mailing Address - Country:US
Mailing Address - Phone:336-664-6248
Mailing Address - Fax:336-217-7237
Practice Address - Street 1:815 W MARKET ST
Practice Address - Street 2:DIVISION OF KINESIOLOGY
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1823
Practice Address - Country:US
Practice Address - Phone:336-272-7102
Practice Address - Fax:336-217-7237
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC00762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer