Jacob Branson Shepherd, PT, DPT, LAT, ATC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P18596 Issued in NC

Practice address

2055 Main Ave SE
Hickory, NC 28602-1404

Phone

(828) 455-0941

NPI assigned

Apr 11, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Sports Doc Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Hickory, NC
  • NPI 1235869827
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1428710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1023404589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 TWIN OAKS ST",
            "city": "CLAREMONT",
            "state": "NC",
            "postal_code": "286109522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 MAIN AVE SE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286021404",
            "telephone_number": "828-455-0941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "JACOB",
        "middle_name": "BRANSON",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-11",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P18596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.thesportsdocpt.com",
            "affiliation": "N",
            "address_1": "2055 Main Ave SE",
            "city": "Hickory",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286021404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Liza Merrill Shaw, MA, LMFT, ACHT
• Wesley Mitchell Shaw, DMD
• Laura Shaw Shely, CRNA
• Tyler Gilbert Shely III, LCSW, MSW, ACSW
• Nitin P Shenoy, MD
• Jennifer R Shepherd, MA, LCMHC
• Richard L Sheppard, DC
• Sian Shipley, BCBA
• Susan Elena Shirley, M.D.
• Wendy Shokes, FNP

• Physical Therapist in Hickory, NC
• Providers in Hickory, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.