Provider Demographics
NPI:1568590222
Name:SHILLER, CLIFFORD GALEN (PT)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:GALEN
Last Name:SHILLER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79512-5119
Mailing Address - Country:US
Mailing Address - Phone:325-728-2650
Mailing Address - Fax:325-728-2210
Practice Address - Street 1:997 W. IH 20
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:TX
Practice Address - Zip Code:79512
Practice Address - Country:US
Practice Address - Phone:325-728-3431
Practice Address - Fax:325-728-2210
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist