Provider Demographics
NPI:1083054126
Name:SEYMOUR SPINE & REHABILITATION
Entity type:Organization
Organization Name:SEYMOUR SPINE & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:RHONEA
Authorized Official - Last Name:HENLEY-SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-880-6514
Mailing Address - Street 1:3225 N HIATUS RD UNIT 451988
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33345-8501
Mailing Address - Country:US
Mailing Address - Phone:770-880-6514
Mailing Address - Fax:
Practice Address - Street 1:3225 N HIATUS RD UNIT 451988
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33345-8501
Practice Address - Country:US
Practice Address - Phone:770-880-6514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97055208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL609ZMedicare PIN
HP190AMedicare PIN