Individual
MISS JACQUELINE DAWN SHEPARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
206 RIDGEWOOD AVE, BRANDON, FL 33510-4617
(813) 662-1060
Mailing address
1022 VERSANT DR, APT 103, BRANDON, FL 33511-8855
(813) 323-8623
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 19942
FL
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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