Doctor Name: | JEFFERY ALAN SHEPHERD |
NPI Number: | 1669719571 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CMT |
License Number: | 12148 |
Business Practice Address: | 9108 Laguna Main St Elk Grove, CA - 957587450 |
Business Phone Number: | 9167189459 |
Business Fax Number: | |
Mailing Address: | 8589 Cord Way, SACRAMENTO |
State: | CA |
Postal Code: | 958285896 |
Phone Number: | 9167189459 |
Fax Number: | |
NPI Enumeration Date: | 01/11/2013 |
NPI Last Update Date: | 01/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 12148 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |