Provider Demographics
NPI:1003011107
Name:STANDHART, PHILIP L (MSPT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:L
Last Name:STANDHART
Suffix:
Gender:M
Credentials:MSPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 E TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-6201
Mailing Address - Country:US
Mailing Address - Phone:239-732-9094
Mailing Address - Fax:239-732-9098
Practice Address - Street 1:3841 E TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6201
Practice Address - Country:US
Practice Address - Phone:239-732-9094
Practice Address - Fax:239-732-9098
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109012251S0007X
FLPT254762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports