Provider Demographics
NPI:1306858881
Name:SHEPHERDSON, STEPHANIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:SHEPHERDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:ARENDELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:430 W EDGEWOOD CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2402
Mailing Address - Country:US
Mailing Address - Phone:309-263-4200
Mailing Address - Fax:309-260-4209
Practice Address - Street 1:430 W EDGEWOOD CT
Practice Address - Street 2:SUITE B
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2402
Practice Address - Country:US
Practice Address - Phone:309-263-4200
Practice Address - Fax:309-260-4209
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist