Provider Demographics
NPI:1811057953
Name:SHEPHERD, MARIA KAI (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:KAI
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 HANNON AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1244
Mailing Address - Country:US
Mailing Address - Phone:251-476-9364
Mailing Address - Fax:
Practice Address - Street 1:67 E MIDTOWN PARK
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4141
Practice Address - Country:US
Practice Address - Phone:251-476-1279
Practice Address - Fax:251-476-2882
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist