Provider Demographics
NPI:1700514114
Name:STANFILL, GREGORY W (DPT, PT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
Last Name:STANFILL
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12923 DOVE OAKS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-4301
Mailing Address - Country:US
Mailing Address - Phone:713-878-7466
Mailing Address - Fax:
Practice Address - Street 1:2004 LEELAND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-5133
Practice Address - Country:US
Practice Address - Phone:713-223-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1366576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist