MEDICARE: MR. STEVEN SHEPHERD P.T.

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
1	225100000X	Physical Therapist	006144	KY

General Provider Information

NPI Number	:	1700121274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN SHEPHERD P.T.

Provider Business Mailing Address
First Line	:	3285 CREEK PATH LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-1186
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	827 LANE ALLEN RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3605
Country	:	US
Telephone Number	:	859-253-9953
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2012
Last Update Date	:	07/22/2013

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