Provider Demographics
NPI:1538203708
Name:SHEPARD, ROBIN L (MSPT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 THOMPSON ST
Mailing Address - Street 2:#145
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2806
Mailing Address - Country:US
Mailing Address - Phone:828-606-6683
Mailing Address - Fax:
Practice Address - Street 1:224 THOMPSON ST
Practice Address - Street 2:#145
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2806
Practice Address - Country:US
Practice Address - Phone:828-606-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4217225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7201061Medicaid