Provider Demographics
NPI:1740357482
Name:SHEPARD, EILEEN RUTHE (PT)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:RUTHE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:174 BULL PATH
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-4601
Mailing Address - Country:US
Mailing Address - Phone:917-750-1080
Mailing Address - Fax:
Practice Address - Street 1:219 E 69TH ST
Practice Address - Street 2:SUITE 1K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5452
Practice Address - Country:US
Practice Address - Phone:212-772-1904
Practice Address - Fax:212-772-1970
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ23721Medicare ID - Type UnspecifiedPHYSICAL THERAPY