Healthcare Provider Details

I. General information

NPI: 1750216735
Provider Name (Legal Business Name): TYLER HENSON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1779 GREEN BAY RD
HIGHLAND PARK IL
60035-3118
US

IV. Provider business mailing address

1779 GREEN BAY RD
HIGHLAND PARK IL
60035-3118
US

V. Phone/Fax

Practice location:
  • Phone: 847-266-0131
  • Fax: 847-266-0127
Mailing address:
  • Phone: 847-266-0131
  • Fax: 847-266-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.023880
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: