MEDICARE: LAWRENCE W. SHEPHARD 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	PT6060	CA

General Provider Information

NPI Number	:	1811998149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE W. SHEPHARD P,T,

Provider Business Mailing Address
First Line	:	441 MARCH AVE
Second Line	:	SUITE B
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3363
Country	:	US
Telephone Number	:	707-433-5219
Fax Number	:	707-433-5248

Provider Business Practice Location Address
First Line	:	441 MARCH AVE
Second Line	:	SUITE B
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3363
Country	:	US
Telephone Number	:	707-433-5219
Fax Number	:	707-433-5248

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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