Individual provider Active NPI

Scott W Tyree, PT

  • Physical Therapist
  • Daytona Beach, FL
National Provider Identifier
1417033424
Registry record updated May 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2256 Issued in WV
Practice address
2441 Bellevue Avenue Extension
Daytona Beach, FL 32114
Phone
(386) 274-2520
Fax
(386) 274-2521
NPI assigned
Oct 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2256 WV Primary
Physical Therapist 225100000X 25452 FL

Addresses

Primary practice location

2441 Bellevue Avenue Extension
Daytona Beach, FL 32114

Mailing address

2441 Bellevue Avenue Extension
Daytona Beach, FL 32114
Phone (386) 274-2520

Other identifiers 3

IdentifierTypeStateIssuer
001722114OtherWVBLUE CROSS BLUE SHIELD
204132970OtherWVWV WORKERS COMP
2204007002MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2256WVMDEmergency Medicine Physician
25452FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy & Wellness in Motion, Inc Past Accepting new patients
Elk Valley Physical Therapy Inc Physical Therapist Past Accepting new patients
Greenbrier Valley Physical Therapy, LLC Past Accepting new patients
Elk Valley Health & Wellness PastSince Apr 23, 2016 Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274140800000",
    "number": "1417033424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2441 BELLEVUE AVENUE EXTENSION",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-274-2520",
            "fax_number": "386-274-2521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2441 BELLEVUE AVENUE EXTENSION",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-274-2520",
            "fax_number": "386-274-2521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYREE",
        "first_name": "SCOTT",
        "middle_name": "W",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2010-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "2256",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "25452",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "001722114",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV WORKERS COMP",
            "identifier": "204132970",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2204007002",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.