Provider Demographics
NPI:1275769341
Name:SHEPHERD, JEREMY M (ATC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:M
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 SILVER KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-9600
Mailing Address - Country:US
Mailing Address - Phone:304-758-9000
Mailing Address - Fax:
Practice Address - Street 1:1993 SILVER KNIGHT DR
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-9600
Practice Address - Country:US
Practice Address - Phone:304-758-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0010382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer