Provider Demographics
NPI:1720736721
Name:SHEPPARD, RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 RAMAH RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-6949
Mailing Address - Country:US
Mailing Address - Phone:609-364-7718
Mailing Address - Fax:
Practice Address - Street 1:331 TILTON RD STE 7
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1201
Practice Address - Country:US
Practice Address - Phone:609-246-5589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02079100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist