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General NPI Number Information
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NPI Number | 1417935610
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Entity Type | Organization
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Legal Business Name | SHEPARD PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 E 69TH ST SUITE 2C
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City | NEW YORK
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State | NY
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Zip | 10021-5471
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Country | US
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Telephone | 212-772-1904
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Fax | 212-772-1970
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Provider Business Mailing Address
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Address Line | 201 E 69TH ST SUITE 2C
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City | NEW YORK
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State | NY
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Zip | 10021-5471
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Country | US
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Telephone | 212-772-1904
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Fax | 212-772-1970
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. EILEEN SHEPARD
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Credential | P.T.
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Telephone | 212-772-1904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 003162
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License Number State | NY
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