Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 3227 | AZ |
NPI | 1023579653 |
---|---|
Provider Name | Sheryl Lynn Viltrakis |
First Address | Phoenix, AZ 85048-6201 |
Second Address | Phoenix, AZ 85048-6201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |