Provider Demographics
NPI:1790720571
Name:DELMONICO, TYRONE RICHARD (MSPT)
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:RICHARD
Last Name:DELMONICO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MATHEWS DR
Mailing Address - Street 2:STE D5
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-3734
Mailing Address - Country:US
Mailing Address - Phone:843-681-5640
Mailing Address - Fax:843-681-5631
Practice Address - Street 1:95 MATHEWS DR
Practice Address - Street 2:STE D5
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-3734
Practice Address - Country:US
Practice Address - Phone:843-681-5640
Practice Address - Fax:843-681-5631
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00179664OtherRAILROAD PROVIDER NUMBER
SCP00640591OtherRAILROAD PTAN
SCP00640591OtherRAILROAD MEDICARE
SC187344OtherMEDCOST PROVIDER NUMBER
SCQ332558783Medicare PIN
SCP00179664OtherRAILROAD PROVIDER NUMBER