| Doctor Name: | JAY RICHARD SHEPHERD |
| NPI Number: | 1275622011 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. |
| License Number: | 17223 |
| Business Practice Address: | 19231 Montgomery Village Ave Suite D21 Montgomery Village, MD - 208865023 |
| Business Phone Number: | 3019776777 |
| Business Fax Number: | 3015279337 |
| Mailing Address: | Po Box 987, OLNEY |
| State: | MD |
| Postal Code: | 208300987 |
| Phone Number: | 3017749300 |
| Fax Number: | 3017748279 |
| NPI Enumeration Date: | 10/12/2006 |
| NPI Last Update Date: | 11/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 17223 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |