Provider Demographics
NPI:1124119011
Name:SHEPHERD, MARCIA JANE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:JANE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:104 LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5831
Mailing Address - Country:US
Mailing Address - Phone:501-837-3120
Mailing Address - Fax:501-819-0711
Practice Address - Street 1:2701 T P WHITE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-2514
Practice Address - Country:US
Practice Address - Phone:501-241-0410
Practice Address - Fax:501-241-0125
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPT 2238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137014721Medicaid
AR5U878OtherAR BLUE CROSS/BLUE SHIELD