Provider Demographics
NPI:1073338810
Name:SEYMOUR, LANE (PT)
Entity type:Individual
Prefix:
First Name:LANE
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:M
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:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:CHINOOK
Mailing Address - State:MT
Mailing Address - Zip Code:59523-1149
Mailing Address - Country:US
Mailing Address - Phone:406-357-2549
Mailing Address - Fax:406-357-2093
Practice Address - Street 1:125 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CHINOOK
Practice Address - State:MT
Practice Address - Zip Code:59523-1149
Practice Address - Country:US
Practice Address - Phone:406-357-2549
Practice Address - Fax:406-357-2093
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-27202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist