Provider Demographics
NPI:1942281332
Name:LIGGETT, ALLAN JOHN (ATC)
Entity type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:JOHN
Last Name:LIGGETT
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 1:2321 W DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8670
Mailing Address - Country:US
Mailing Address - Phone:417-883-6341
Mailing Address - Fax:
Practice Address - Street 1:2135 EAST CHEROKEE
Practice Address - Street 2:MIDWEST SPORTS MEDICINE CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-820-7990
Practice Address - Fax:417-820-8734
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer