Provider Demographics
NPI:1114365087
Name:TYREE, ANTOINE (PT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANTOINE
Middle Name:
Last Name:TYREE
Suffix:
Gender:M
Credentials:PT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N TRAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4012
Mailing Address - Country:US
Mailing Address - Phone:281-592-2884
Mailing Address - Fax:281-592-3269
Practice Address - Street 1:102 N TRAVIS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4012
Practice Address - Country:US
Practice Address - Phone:281-592-2884
Practice Address - Fax:281-592-3269
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115154225X00000X
TX1229441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist