Individual
JUSTIN RYAN SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT6646
TN
225100000X
Physical Therapist
Primary
PTH7280
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3658050
—
TN
01
—
4111092
BCBST
TN
05
—
5441656
—
TN
Enumeration date
06/02/2006
Last updated
02/09/2024
Update your record
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