Provider Demographics
NPI:1710560321
Name:TYRE PHYSICAL THERAPY & PERFORMANCE, LLC
Entity type:Organization
Organization Name:TYRE PHYSICAL THERAPY & PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC
Authorized Official - Phone:302-648-5060
Mailing Address - Street 1:18 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-9483
Mailing Address - Country:US
Mailing Address - Phone:410-251-8189
Mailing Address - Fax:
Practice Address - Street 1:24077 COUNTRY LIVING RD STE 8
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-2852
Practice Address - Country:US
Practice Address - Phone:410-251-8189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-01
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty