Provider Demographics
NPI:1245668003
Name:SHEPHERD, MARIA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
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 1:37 W GARDEN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2662
Mailing Address - Country:US
Mailing Address - Phone:315-253-3291
Mailing Address - Fax:315-258-8759
Practice Address - Street 1:37 W GARDEN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2662
Practice Address - Country:US
Practice Address - Phone:315-253-3291
Practice Address - Fax:315-258-8759
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62-022424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist