Provider Demographics
NPI:1447216759
Name:TYRE, ANGELA C (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:TYRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:CASAGRANDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:550 PEACHTREE STREET
Mailing Address - Street 2:19TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-215-2050
Mailing Address - Fax:404-215-2051
Practice Address - Street 1:550 PEACHTREE STREET
Practice Address - Street 2:19TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-215-2050
Practice Address - Fax:404-215-2051
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0065952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic