MEDICARE: PENNY TYLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist		CA

General Provider Information

NPI Number	:	1740161264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNY TYLER

Provider Business Mailing Address
First Line	:	928 S HARLAN AVE
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90220-4214
Country	:	US
Telephone Number	:	310-766-3999
Fax Number	:

Provider Business Practice Location Address
First Line	:	3490 LINDEN AVE STE 3
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-4559
Country	:	US
Telephone Number	:	310-766-3999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	09/10/2025

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Directions to “ PENNY TYLER ” Practice Location

Language	Start Address	Practice Location

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