Provider Demographics
NPI:1982768917
Name:SEYMOUR, STACEY L (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5477 E HINSDALE PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2540
Mailing Address - Country:US
Mailing Address - Phone:303-470-1737
Mailing Address - Fax:
Practice Address - Street 1:5161 E ARAPAHOE RD
Practice Address - Street 2:STE 152
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-2387
Practice Address - Country:US
Practice Address - Phone:303-694-6378
Practice Address - Fax:303-694-6379
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist