Provider Demographics
NPI:1265935720
Name:CASE, PHILIP HAROLD (BACHELOR OF ARTS)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:HAROLD
Last Name:CASE
Suffix:
Gender:M
Credentials:BACHELOR OF ARTS
Other - Prefix:MR
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19009 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967
Mailing Address - Country:US
Mailing Address - Phone:941-356-4432
Mailing Address - Fax:
Practice Address - Street 1:8591 LAKESIDE DR.
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL247200000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other