1093780793 NPI number — MRS. ALLISON PAGE SHEPHERD MA, ATC

Table of content: MRS. ALLISON PAGE SHEPHERD MA, ATC (NPI 1093780793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093780793 NPI number — MRS. ALLISON PAGE SHEPHERD MA, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEPHERD
Provider First Name:
ALLISON
Provider Middle Name:
PAGE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093780793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
323 BISCAYNE HTS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLCHESTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05446-6934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-656-9022
Provider Business Mailing Address Fax Number:
802-656-9578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF VERMONT
Provider Second Line Business Practice Location Address:
140 PATRICK GYM/97 SPEAR ST.
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05405-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-656-9022
Provider Business Practice Location Address Fax Number:
802-656-9578
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  104-0000132 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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