Provider Demographics
NPI:1972670495
Name:SHEPPARD, LORI-ANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:LORI-ANNE
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 CUSTIS ST
Mailing Address - Street 2:APT F
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3246
Mailing Address - Country:US
Mailing Address - Phone:410-583-1515
Mailing Address - Fax:410-583-2491
Practice Address - Street 1:1026 CROMWELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3308
Practice Address - Country:US
Practice Address - Phone:410-583-1515
Practice Address - Fax:410-583-2491
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist