MEDICARE: EUNICE SHEPHERD DPT

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	PT295586	CA

General Provider Information

NPI Number	:	1811526320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNICE SHEPHERD DPT

Provider Business Mailing Address
First Line	:	7077 WILLOUGHBY AVE APT 617
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2389
Country	:	US
Telephone Number	:	850-549-6185
Fax Number	:

Provider Business Practice Location Address
First Line	:	7077 WILLOUGHBY AVE APT 617
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2389
Country	:	US
Telephone Number	:	850-549-6185
Fax Number	:

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

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	04/06/2020

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Directions to “ EUNICE SHEPHERD DPT” Practice Location

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