Provider Demographics
NPI:1215605373
Name:SHEPPARD, KALA DANIELLE (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:KALA
Middle Name:DANIELLE
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:PT, DPT, ATC
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 257
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-0257
Mailing Address - Country:US
Mailing Address - Phone:417-221-4667
Mailing Address - Fax:417-744-9674
Practice Address - Street 1:304 E JACKSON ST STE 2F
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9333
Practice Address - Country:US
Practice Address - Phone:417-221-4667
Practice Address - Fax:417-744-9674
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021031337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist