| NPI | 1043746100 |
|---|---|
| Former Name | ELISSA MARIE SHEPARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23503) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT012610) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2018-02-28 |