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General NPI Number Information
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NPI Number | 1548292311
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Entity Type | Individual
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Provider Name | DR. PHILLIP TYRE
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 05/07/2023
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Provider Practice Location Address
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Address Line | 24077 COUNTRY LIVING ROAD SUITE 8
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City | MILLSBORO
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State | DE
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Zip | 19966
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Country | US
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Telephone | 302-648-5060
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Fax | 302-316-3049
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Provider Business Mailing Address
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Address Line | 24077 COUNTRY LIVING ROAD SUITE 8
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City | MILLSBORO
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State | DE
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Zip | 19966
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Country | US
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Telephone | 302-648-5060
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Fax | 302-316-3049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0002563
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018143
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License Number State | PA
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