Healthcare Provider Details

I. General information

NPI: 1417391186
Provider Name (Legal Business Name): HEATHER ELAINE SHEPPARD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SOUTH 336TH ST SUITE 210
FEDERAL WAY WA
98003
US

IV. Provider business mailing address

6051 137TH AVE NE APT 345
REDMOND WA
98052-4584
US

V. Phone/Fax

Practice location:
  • Phone: 866-835-8091
  • Fax:
Mailing address:
  • Phone: 425-269-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT 00009643
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: