Provider Demographics
NPI:1437341815
Name:SHEPARD, DENNIS ANTHONY (LPTA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ANTHONY
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4081 WINTERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9793
Mailing Address - Country:US
Mailing Address - Phone:440-964-2397
Mailing Address - Fax:
Practice Address - Street 1:4081 WINTERGREEN DR
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9793
Practice Address - Country:US
Practice Address - Phone:440-964-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2285225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant