Provider Demographics
NPI:1902806623
Name:SEYMOUR, RONALD JAMES (PT)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
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 1:12132 SE 91ST TERR
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:34491
Mailing Address - Country:US
Mailing Address - Phone:352-553-4886
Mailing Address - Fax:
Practice Address - Street 1:600 N BLVD WEST
Practice Address - Street 2:SUITE D
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5063
Practice Address - Country:US
Practice Address - Phone:352-787-9300
Practice Address - Fax:352-259-0002
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0030501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S79523Medicare UPIN
NYBB4668Medicare ID - Type Unspecified