Provider Demographics
NPI:1417033424
Name:TYREE, SCOTT W (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:TYREE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 BELLEVUE AVENUE EXTENSION
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114
Mailing Address - Country:US
Mailing Address - Phone:386-274-2520
Mailing Address - Fax:386-274-2521
Practice Address - Street 1:2441 BELLEVUE AVENUE EXTENSION
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-274-2520
Practice Address - Fax:386-274-2521
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2256225100000X
FL25452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722114OtherBLUE CROSS BLUE SHIELD
WV204132970OtherWV WORKERS COMP
WV2204007002Medicaid
WV4119563Medicare PIN