Provider Demographics
NPI:1063172138
Name:SEYMOUR, COURTNEY LYNNE (PTA, BS)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:LYNNE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PTA, BS
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Mailing Address - Street 1:5237 GRASSHOPPER RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-9386
Mailing Address - Country:US
Mailing Address - Phone:919-816-5805
Mailing Address - Fax:
Practice Address - Street 1:1151 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9646
Practice Address - Country:US
Practice Address - Phone:919-891-6662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCA7584225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant