Healthcare Provider Details

I. General information

NPI: 1083054126
Provider Name (Legal Business Name): SEYMOUR SPINE & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 N HIATUS RD UNIT 451988
SUNRISE FL
33345-8501
US

IV. Provider business mailing address

3225 N HIATUS RD UNIT 451988
SUNRISE FL
33345-8501
US

V. Phone/Fax

Practice location:
  • Phone: 770-880-6514
  • Fax:
Mailing address:
  • Phone: 770-880-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME97055
License Number StateFL

VIII. Authorized Official

Name: ANDREA RHONEA HENLEY-SEYMOUR
Title or Position: MANAGER
Credential: M.D.
Phone: 770-880-6514