Provider Demographics
NPI:1083054126
Name:SEYMOUR SPINE & REHABILITATION
Entity Type:Organization
Organization Name:SEYMOUR SPINE & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:RHONEA
Authorized Official - Last Name:HENLEY-SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-315-7978
Mailing Address - Street 1:4399 N NOB HILL RD
Mailing Address - Street 2:ATTN: ANDREA HENLEY-SEYMOUR, MD
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5813
Mailing Address - Country:US
Mailing Address - Phone:954-315-7978
Mailing Address - Fax:954-746-1438
Practice Address - Street 1:4399 N NOB HILL RD
Practice Address - Street 2:ATTN: ANDREA HENLEY-SEYMOUR, MD
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-5813
Practice Address - Country:US
Practice Address - Phone:954-315-7978
Practice Address - Fax:954-746-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97055208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL609ZMedicare PIN
HP190AMedicare PIN