Individual provider Active NPI

Adina Lynelle Verrett Myles, P.T.

  • Physical Therapist
  • Elk Grove, CA
National Provider Identifier
1467779041
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
17201 Issued in CA
Practice address
9372 Canter Drive
Elk Grove, CA 95624
Phone
(301) 452-4261
NPI assigned
Apr 22, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

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 17201 CA Primary

Addresses

Primary practice location

9372 Canter Drive
Elk Grove, CA 95624

Mailing address

PO Box 311
Glenelg, MD 21737-0311
Phone (301) 452-4261

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140618000666 CA Practitioner - Physical Therapist in Private Practice 8325262124 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Restored Therapy and Wellness, LLC CurrentSince May 3, 2020 Accepting new patients
In-Home Physical Therapy PC CurrentSince Feb 1, 2014 Accepting new patients

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": "1271894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593475200000",
    "number": "1467779041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 311",
            "city": "GLENELG",
            "state": "MD",
            "postal_code": "217370311",
            "telephone_number": "301-452-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9372 CANTER DRIVE",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "95624",
            "telephone_number": "301-452-4261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERRETT MYLES",
        "first_name": "ADINA",
        "middle_name": "LYNELLE",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-22",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "17201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.