Provider Demographics
NPI:1023579653
Name:VILTRAKIS, SHERYL LYNN (PT)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:LYNN
Last Name:VILTRAKIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 E THUNDERHILL PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-6201
Mailing Address - Country:US
Mailing Address - Phone:602-770-2563
Mailing Address - Fax:
Practice Address - Street 1:1321 E THUNDERHILL PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-6201
Practice Address - Country:US
Practice Address - Phone:602-770-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3227208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation