Provider Demographics
NPI:1093043622
Name:SHEPHERD, TRENTON B (PT)
Entity Type:Individual
Prefix:
First Name:TRENTON
Middle Name:B
Last Name:SHEPHERD
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 1:101 ISADORE ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5747
Mailing Address - Country:US
Mailing Address - Phone:318-238-2810
Mailing Address - Fax:318-238-2811
Practice Address - Street 1:6723 PINES RD STE 112
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2590
Practice Address - Country:US
Practice Address - Phone:318-562-3944
Practice Address - Fax:318-562-3945
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist