Provider Demographics
NPI:1871794537
Name:PHILIPS, CLARKE ANDREW (PT, MHS)
Entity type:Individual
Prefix:MR
First Name:CLARKE
Middle Name:ANDREW
Last Name:PHILIPS
Suffix:
Gender:M
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 SE 36TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:SC
Mailing Address - Zip Code:33904
Mailing Address - Country:US
Mailing Address - Phone:864-232-6957
Mailing Address - Fax:864-232-6957
Practice Address - Street 1:216 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2031
Practice Address - Country:US
Practice Address - Phone:239-242-0549
Practice Address - Fax:239-242-0549
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2668OtherSC PT LICENSE