Provider Demographics
NPI:1235975780
Name:HULETT, TYCHELE A (PTA, LMT, CLT, CCST)
Entity type:Individual
Prefix:
First Name:TYCHELE
Middle Name:A
Last Name:HULETT
Suffix:
Gender:F
Credentials:PTA, LMT, CLT, CCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 E PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2847
Mailing Address - Country:US
Mailing Address - Phone:480-282-7124
Mailing Address - Fax:
Practice Address - Street 1:183 E WILLIAMS FIELD RD STE E-105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-5222
Practice Address - Country:US
Practice Address - Phone:480-282-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-19660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist