Provider Demographics
NPI:1225523178
Name:SEYMOUR, KYLE (ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SEYMOUR
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 1:522 E HANNA DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2702
Mailing Address - Country:US
Mailing Address - Phone:302-562-9609
Mailing Address - Fax:
Practice Address - Street 1:1010 WAYNE AVE STE 410
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5655
Practice Address - Country:US
Practice Address - Phone:240-600-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00010892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer