Provider Demographics
NPI:1760134175
Name:CARTER, TYLIK (CMT)
Entity Type:Individual
Prefix:
First Name:TYLIK
Middle Name:
Last Name:CARTER
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14921 S STANFORD AVE APT G244
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-1161
Mailing Address - Country:US
Mailing Address - Phone:702-807-7931
Mailing Address - Fax:
Practice Address - Street 1:14921 S STANFORD AVE APT G244
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-1161
Practice Address - Country:US
Practice Address - Phone:702-807-7931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88708225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist