Kyla Gelina Sulcer, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160.007051 Issued in IL

Practice address

1191 Fortune Blvd Ste 2
Shiloh, IL 62269-7474

Phone

(618) 607-0061

Fax

(618) 615-4290

NPI assigned

Feb 14, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Metro East Dermatology & Skin Cancer Center LLC

  • Dermatology Physician
  • Shiloh, IL
  • NPI 1518494996
  NPD
• Mitas LLC

  • Orthopaedic Surgery Physician
  • Shiloh, IL
  • NPI 1659967917
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1558068171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1191 FORTUNE BLVD STE 2",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697474",
            "telephone_number": "618-607-0061",
            "fax_number": "618-615-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 FORTUNE BLVD STE 2",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697474",
            "telephone_number": "618-607-0061",
            "fax_number": "618-615-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULCER",
        "first_name": "KYLA",
        "middle_name": "GELINA",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-14",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.007051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St Louis Dental Implant Group
• Haley St Peters, CNM
• St. Louis JC Vamc
• Holly Laura Steiner, MD
• Dustin Storck, D.P.T.
• Umar Tariq, M.D.
• The Rehabilitation Institute of Southern Illinois,LLC
• Samantha An Tilley, MS, RDN, LDN
• Total Renal Care Inc
• Sydnie Elizabeth Twillmann, PHARMD

• Physical Therapy Assistant in Shiloh, IL
• Providers in Shiloh, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.