Provider Demographics
NPI:1144401605
Name:SEYMOUR, JAMES KEVIN (PHY THERAPY)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:PHY THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204630
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30917-4630
Mailing Address - Country:US
Mailing Address - Phone:706-722-6957
Mailing Address - Fax:706-722-7454
Practice Address - Street 1:840 STEVENS CREEK RAOD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-722-6957
Practice Address - Fax:706-722-7454
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55I650076Medicare PIN