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General NPI Number Information
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NPI Number | 1083054126
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Entity Type | Organization
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Legal Business Name | SEYMOUR SPINE & REHABILITATION
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 3225 N HIATUS RD UNIT 451988
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City | SUNRISE
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State | FL
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Zip | 33345-8501
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Country | US
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Telephone | 770-880-6514
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 N HIATUS RD UNIT 451988
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City | SUNRISE
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State | FL
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Zip | 33345-8501
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Country | US
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Telephone | 770-880-6514
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANDREA RHONEA HENLEY-SEYMOUR
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Credential | M.D.
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Telephone | 770-880-6514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME97055
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License Number State | FL
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