Healthcare Provider Details

I. General information

NPI: 1902806623
Provider Name (Legal Business Name): RONALD JAMES SEYMOUR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N BLVD WEST SUITE D
LEESBURG FL
34748-5063
US

IV. Provider business mailing address

12132 SE 91ST TERR
SUMMERFIELD NY
34491
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-9300
  • Fax: 352-259-0002
Mailing address:
  • Phone: 352-553-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0030501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: