Provider Demographics
NPI:1881268084
Name:HUNT, TYLYNN MACKENZIE (CMT)
Entity type:Individual
Prefix:
First Name:TYLYNN
Middle Name:MACKENZIE
Last Name:HUNT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E PALM AVE APT 138
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1243
Mailing Address - Country:US
Mailing Address - Phone:320-533-1270
Mailing Address - Fax:
Practice Address - Street 1:8500 MELROSE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-5169
Practice Address - Country:US
Practice Address - Phone:310-927-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83045225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist