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NPI Code Detail

MEDICARE: DOUGLAS SHEPHERD PT

MEDICARE: DOUGLAS SHEPHERD PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4929944-2401UT

General Provider Information

NPI Number : 1215962337
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS SHEPHERD PT
Provider Business Mailing Address
First Line : 3031 N 1300 E
Second Line :
City : NORTH OGDEN
State : UT
Zip : 84414-1817
Country : US
Telephone Number : 801-781-0651
Fax Number :
Provider Business Practice Location Address
First Line : 524 E 800 N
Second Line :
City : OGDEN
State : UT
Zip : 84404-3600
Country : US
Telephone Number : 801-782-3740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/08/2007

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Directions to “ DOUGLAS SHEPHERD PT” Practice Location

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