Provider Demographics
NPI:1427923119
Name:SHILTON, TYLER JAMES (LMT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:SHILTON
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 1:301 GOLD AVE NW APT 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5509
Mailing Address - Country:US
Mailing Address - Phone:616-216-5662
Mailing Address - Fax:
Practice Address - Street 1:2215 OAK INDUSTRIAL DR NE STE 212
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-6037
Practice Address - Country:US
Practice Address - Phone:616-216-5662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501016976225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty