Provider Demographics
NPI:1972644136
Name:VILHAUER, MARYBETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:VILHAUER
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 1:2701 S KIWANIS AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4252
Mailing Address - Country:US
Mailing Address - Phone:605-332-0003
Mailing Address - Fax:605-328-9101
Practice Address - Street 1:2701 S KIWANIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4252
Practice Address - Country:US
Practice Address - Phone:605-332-0003
Practice Address - Fax:605-328-9101
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4884Medicaid