Provider Demographics
NPI:1497593602
Name:SHEPARDSON PHYSICAL THERAPY CORPORATION
Entity type:Organization
Organization Name:SHEPARDSON PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:SHEPARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:831-999-0880
Mailing Address - Street 1:952 KENNEDY DR APT B
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2372
Mailing Address - Country:US
Mailing Address - Phone:831-999-0880
Mailing Address - Fax:831-401-2398
Practice Address - Street 1:4630 SOQUEL DR STE 2
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2180
Practice Address - Country:US
Practice Address - Phone:831-999-0880
Practice Address - Fax:831-401-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy