Provider Demographics
NPI:1982469490
Name:SEYMORE, GOR'DASIA (LMT)
Entity Type:Individual
Prefix:
First Name:GOR'DASIA
Middle Name:
Last Name:SEYMORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 E MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2579
Mailing Address - Country:US
Mailing Address - Phone:614-237-6373
Mailing Address - Fax:
Practice Address - Street 1:2740 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2579
Practice Address - Country:US
Practice Address - Phone:614-237-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-026596225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty