Provider Demographics
NPI:1235643370
Name:SHEPARDSON, JASON OLIVER (DPT, PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:OLIVER
Last Name:SHEPARDSON
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 KENNEDY DR APT B
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2372
Mailing Address - Country:US
Mailing Address - Phone:408-348-1893
Mailing Address - Fax:
Practice Address - Street 1:952 KENNEDY DR APT B
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2372
Practice Address - Country:US
Practice Address - Phone:408-348-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2941412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic