Provider Demographics
NPI:1093540049
Name:SEYMOUR, CAMERON TAYLOR (PT, DPT)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:TAYLOR
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:SEYMOUR
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2111 LINGNER DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3522
Mailing Address - Country:US
Mailing Address - Phone:903-235-2792
Mailing Address - Fax:
Practice Address - Street 1:4882 HIGHTECH DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2613
Practice Address - Country:US
Practice Address - Phone:903-300-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1388709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist