Provider Demographics
NPI:1124145800
Name:SEYMOUR, KATIE M (MPT)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:M
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 20281
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-8281
Mailing Address - Country:US
Mailing Address - Phone:716-361-6536
Mailing Address - Fax:
Practice Address - Street 1:2601A DEMERE RD
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1614
Practice Address - Country:US
Practice Address - Phone:912-634-9945
Practice Address - Fax:912-638-1584
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT007583OtherTHERAPIST LICENSE NUMBER