Provider Demographics
NPI:1710481015
Name:SHEPHARD, CAROLINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:SHEPHARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:KREUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2020 NE LINNEA DR APT 267
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4980
Mailing Address - Country:US
Mailing Address - Phone:503-481-0413
Mailing Address - Fax:
Practice Address - Street 1:1303 NE CUSHING DR STE 150
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3891
Practice Address - Country:US
Practice Address - Phone:541-382-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist