Provider Demographics
NPI:1043091929
Name:TYLER, TERESA
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33141 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92276-3934
Mailing Address - Country:US
Mailing Address - Phone:760-222-0040
Mailing Address - Fax:
Practice Address - Street 1:33141 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:THOUSAND PALMS
Practice Address - State:CA
Practice Address - Zip Code:92276-3934
Practice Address - Country:US
Practice Address - Phone:760-222-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist