Healthcare Provider Details

I. General information

NPI: 1124119011
Provider Name (Legal Business Name): MARCIA JANE SHEPHERD M.S.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 T P WHITE DR
JACKSONVILLE AR
72076-2514
US

IV. Provider business mailing address

104 LITTLE CREEK RD
SHERWOOD AR
72120-5831
US

V. Phone/Fax

Practice location:
  • Phone: 501-241-0410
  • Fax: 501-241-0125
Mailing address:
  • Phone: 501-837-3120
  • Fax: 501-819-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 2238
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: