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General NPI Number Information
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NPI Number | 1043649049
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Entity Type | Individual
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Provider Name | MATTHEW STILLE
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Gender | Male
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Dates
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Enumeration Date | 11/11/2013
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Last Update Date | 11/11/2013
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Provider Practice Location Address
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Address Line | 848 1ST AVE N STE 120
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City | NAPLES
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State | FL
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Zip | 34102-6013
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Country | US
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Telephone | 239-384-5952
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Fax |
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Provider Business Mailing Address
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Address Line | 23159 AMGCI WAY UNIT 315
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City | ESTERO
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State | FL
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Zip | 33928-2593
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Country | US
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Telephone | 305-606-5676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT28822
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License Number State | FL
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