Provider Demographics
NPI:1033258025
Name:SHEPARD, SCOTT RYAN (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RYAN
Last Name:SHEPARD
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 1:677 PICKFAIR TER
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5816
Mailing Address - Country:US
Mailing Address - Phone:407-222-7489
Mailing Address - Fax:
Practice Address - Street 1:125 W PINEVIEW ST
Practice Address - Street 2:SUITE 1009
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2007
Practice Address - Country:US
Practice Address - Phone:407-830-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist