Provider Demographics
NPI:1548292311
Name:TYRE, PHILLIP
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:TYRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24077 COUNTRY LIVING ROAD SUITE 8
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966
Mailing Address - Country:US
Mailing Address - Phone:302-648-5060
Mailing Address - Fax:302-316-3049
Practice Address - Street 1:24077 COUNTRY LIVING ROAD SUITE 8
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-648-5060
Practice Address - Fax:302-316-3049
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002563225100000X
PAPT018143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD175281ZBL8Medicare PIN