Provider Demographics
NPI:1033646922
Name:SHEPHARD, KATHERINE MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:SHEPHARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 HOLTON ST
Mailing Address - Street 2:
Mailing Address - City:FALCON HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6224
Mailing Address - Country:US
Mailing Address - Phone:651-792-6180
Mailing Address - Fax:
Practice Address - Street 1:1939 MINNEHAHA AVE W STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1033
Practice Address - Country:US
Practice Address - Phone:651-348-7428
Practice Address - Fax:651-348-7432
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist