Provider Demographics
NPI:1386690717
Name:SHEPHERD, JAMES MR (DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MR
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17903 16TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4048
Mailing Address - Country:US
Mailing Address - Phone:425-984-4426
Mailing Address - Fax:
Practice Address - Street 1:17903 16TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4048
Practice Address - Country:US
Practice Address - Phone:425-984-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8435596Medicaid
WA0200941OtherWA STATE L&I
WA9516SHOtherREGENCE BLUE SHIELD
WAQ52913Medicare UPIN
WA8856094Medicare ID - Type Unspecified