Healthcare Provider Details

I. General information

NPI: 1003011107
Provider Name (Legal Business Name): PHILIP L STANDHART MSPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 E TAMIAMI TRL
NAPLES FL
34112-6201
US

IV. Provider business mailing address

3841 E TAMIAMI TRL
NAPLES FL
34112-6201
US

V. Phone/Fax

Practice location:
  • Phone: 239-732-9094
  • Fax: 239-732-9098
Mailing address:
  • Phone: 239-732-9094
  • Fax: 239-732-9098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number10901
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT25476
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: