Provider Demographics
NPI:1366460313
Name:SEYMOUR, NATHANAEL ROBERT (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:NATHANAEL
Middle Name:ROBERT
Last Name:SEYMOUR
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6083 SINGLETREE LANE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2423
Mailing Address - Country:US
Mailing Address - Phone:937-438-5307
Mailing Address - Fax:
Practice Address - Street 1:300 COLLEGE PARK
Practice Address - Street 2:UNIVERSITY OF DAYTON
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45469-1220
Practice Address - Country:US
Practice Address - Phone:937-229-4437
Practice Address - Fax:937-229-5448
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-16812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer