Provider Demographics
NPI:1093521940
Name:SHEETS, TYLER JACK (LMT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JACK
Last Name:SHEETS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E SCOTT ST APT 7L
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5272
Mailing Address - Country:US
Mailing Address - Phone:989-325-6435
Mailing Address - Fax:
Practice Address - Street 1:560 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1678
Practice Address - Country:US
Practice Address - Phone:773-524-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.0187277225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist