Provider Demographics
NPI:1043649049
Name:STILLE, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:STILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23159 AMGCI WAY UNIT 315
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2593
Mailing Address - Country:US
Mailing Address - Phone:305-606-5676
Mailing Address - Fax:
Practice Address - Street 1:848 1ST AVE N
Practice Address - Street 2:STE 120
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6013
Practice Address - Country:US
Practice Address - Phone:239-384-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist