Renuka Jain

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

22176 Issued in MD

Practice address

10300B Baltimore National Pike
Ellicott City, MD 21042-2128

Phone

(410) 988-5171

Fax

(410) 988-5349

NPI assigned

Jul 18, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revive Physical Therapy LLCGroup PAC ID 0547427627, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Revive Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Ellicott City, MD
  • NPI 1215204110
  Medicare reassignment Care Compare group NPD Authorized official
• Revive Physical Therapy LLC

  • Physical Therapist
  • Ellicott City, MD
  • NPI 1619827953
  NPD (past) Authorized official
• Revive Physical Therapy LLC

  • Physical Therapist
  • Ellicott City, MD
  • NPI 1679422968
  NPD (past) Authorized official

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416528000000",
    "number": "1194924217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300B BALTIMORE NATIONAL PIKE",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210422128",
            "telephone_number": "410-988-5171",
            "fax_number": "410-988-5349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300B BALTIMORE NATIONAL PIKE",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210422128",
            "telephone_number": "410-988-5171",
            "fax_number": "410-988-5349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAIN",
        "first_name": "RENUKA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-18",
        "last_updated": "2014-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "22176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracie Renee Jackson, RN
• Wayne Jackson, DPT
• Amber Jacobs, MS/CAGS
• Sarah Jacques, LCSW-C
• Jael Health Services, Inc.
• Arti Jaiswal Balchandani, MD
• Chaitanya Jakleti
• Palwole Jang, L.AC.
• Barbara Ann Jaquette, MSW
• Lina Jarboe, DDS, PA

• Physical Therapist in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.