Provider Demographics
NPI:1659623643
Name:SHEPHERD, CHRISTINA LYNN GANEM (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNN GANEM
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JB PHH
Mailing Address - State:HI
Mailing Address - Zip Code:96860-4908
Mailing Address - Country:US
Mailing Address - Phone:808-471-1866
Mailing Address - Fax:808-471-0918
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JB PHH
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-471-1866
Practice Address - Fax:808-471-0918
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1210712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist