Provider Demographics
NPI:1487861969
Name:SEAGO, BOBBY RAY
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:RAY
Last Name:SEAGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 LAKE GROVE LOOP
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5643
Mailing Address - Country:US
Mailing Address - Phone:972-775-4674
Mailing Address - Fax:
Practice Address - Street 1:100 WALTER STEPHENSON RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3418
Practice Address - Country:US
Practice Address - Phone:972-775-8174
Practice Address - Fax:972-775-5139
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT17032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer