Provider Demographics
NPI:1720649510
Name:FAVER, ROSS CLIFTON (MS, ATC/L, CEAS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:CLIFTON
Last Name:FAVER
Suffix:
Gender:M
Credentials:MS, ATC/L, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18411 22ND DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6972
Mailing Address - Country:US
Mailing Address - Phone:602-909-7185
Mailing Address - Fax:
Practice Address - Street 1:18411 22ND DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6972
Practice Address - Country:US
Practice Address - Phone:602-909-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1602155452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer