Provider Demographics
NPI:1528024130
Name:SEYMOUR, ANNA MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:935 EAST AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2031
Mailing Address - Country:US
Mailing Address - Phone:618-258-9093
Mailing Address - Fax:618-258-9097
Practice Address - Street 1:935 EAST AIRLINE DR
Practice Address - Street 2:
Practice Address - City:EAST ALTON
Practice Address - State:IL
Practice Address - Zip Code:62024-2031
Practice Address - Country:US
Practice Address - Phone:618-258-9093
Practice Address - Fax:618-258-9097
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant