Provider Demographics
NPI:1700018199
Name:SEYBOLD, SAM (DPT)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:SEYBOLD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NW 7TH ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1212
Mailing Address - Country:US
Mailing Address - Phone:405-609-3675
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:1726 S DIVISION ST
Practice Address - Street 2:SUITE A
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6019
Practice Address - Country:US
Practice Address - Phone:405-293-6138
Practice Address - Fax:405-293-6252
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist