Healthcare Provider Details

I. General information

NPI: 1669449989
Provider Name (Legal Business Name): JENNIFER SAUNDERS SHEPHERD PT/ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DEER XING
VONORE TN
37885-2133
US

IV. Provider business mailing address

110 DEER XING
VONORE TN
37885-2133
US

V. Phone/Fax

Practice location:
  • Phone: 423-884-1901
  • Fax: 423-884-2686
Mailing address:
  • Phone: 423-884-1901
  • Fax: 423-884-2686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number0000003761
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0000000633
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: