Healthcare Provider Details

I. General information

NPI: 1710560321
Provider Name (Legal Business Name): TYRE PHYSICAL THERAPY & PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2021
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24077 COUNTRY LIVING RD STE 8
MILLSBORO DE
19966-2852
US

IV. Provider business mailing address

18 EVERGREEN DR
GEORGETOWN DE
19947-9483
US

V. Phone/Fax

Practice location:
  • Phone: 410-251-8189
  • Fax:
Mailing address:
  • Phone: 410-251-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP DAVID TYRE
Title or Position: OWNER, CEO
Credential: DPT, ATC
Phone: 302-648-5060