Provider Demographics
NPI:1558750729
Name:SHEPPARD, CASEY POFF (PT)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:POFF
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CASEY
Other - Middle Name:MARIE
Other - Last Name:POFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:DEPARTMENT OF PT/OT
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:984-974-5300
Mailing Address - Fax:984-974-5305
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:DEPARTMENT OF PT/OT
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:984-974-5300
Practice Address - Fax:984-974-5305
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist