Individual provider Active NPI

Tashida A. Deroux, MPT

  • Physical Therapist
  • Clinton, MD
National Provider Identifier
1285699710
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
21066 Issued in MD
Practice address
10403 Hospital Dr
Clinton, MD 20735-3134
Phone
(301) 856-0050
Fax
(301) 856-0518
NPI assigned
Apr 18, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 21066 MD Primary

Addresses

Primary practice location

10403 Hospital Dr
Clinton, MD 20735-3134

Mailing address

7503 Surratts Rd
Clinton, MD 20735-3358
Phone (301) 870-7001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241209003929 DC Practitioner - Physical Therapist in Private Practice 9638605058 Reassigns benefits to 1 organization
I20241224001644 MD Practitioner - Physical Therapist in Private Practice 9638605058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proflex Physical Therapy of Maryland, LLCGroup PAC ID 7416244322, 41 clinicians

Practice addresses (Care Compare)

3320 Crain Hwy
Waldorf, MD 20603-4850
Phone (301) 870-7366

7905 Malcolm Rd
Suite 201
Clinton, MD 20735-1749
Phone (301) 856-0050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Proflex Physical Thearpy of Maryland, LLC CurrentSince Nov 13, 2024 Accepting new patients
Proflex Physical Therapy of Maryland, LLC. Physical Therapist CurrentSince Nov 13, 2024 Accepting new patients

Locations

7905 Malcolm Rd
Ste 201
Clinton, MD 20735
Phone (301) 856-0050

3320 Crain Hwy
Waldorf, MD 20603
Phone (301) 870-7366

Organizations & group practices 2

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": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1285699710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7503 SURRATTS RD",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353358",
            "telephone_number": "301-870-7001",
            "fax_number": "301-870-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10403 HOSPITAL DR",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207353134",
            "telephone_number": "301-856-0050",
            "fax_number": "301-856-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROUX",
        "first_name": "TASHIDA",
        "middle_name": "A.",
        "credential": "MPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "21066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.