Provider Demographics
NPI:1083852289
Name:SHEPHERD, SELINDA A (DPT)
Entity Type:Individual
Prefix:
First Name:SELINDA
Middle Name:A
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-0466
Mailing Address - Country:US
Mailing Address - Phone:860-693-6226
Mailing Address - Fax:860-693-8002
Practice Address - Street 1:65 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2507
Practice Address - Country:US
Practice Address - Phone:860-693-6226
Practice Address - Fax:860-693-8002
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist