NPIMap

Organization Active NPI

Resilient Physiotherapy

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Baltimore, MD
National Provider Identifier
1528614690
Registry record updated Aug 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X
Legal business name
RESILIENT PHYSIOTHERAPY
Practice address
8303 Pulaski Hwy
Baltimore, MD 21237-2962
Phone
(717) 817-4308
NPI assigned
Aug 14, 2019
Last updated
Aug 14, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2019

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

Authorized official

Name
Dr. Jordan Shettle, PT, DPTNPI 1699030262
Title
Doctorate of Physical Therapy
Phone
(717) 817-4308

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2081S0010X Primary

Addresses

Primary practice location

8303 Pulaski Hwy
Baltimore, MD 21237-2962

Mailing address

6221 Greenleigh Ave Unit 515
Baltimore, MD 21220-2038
Phone (717) 817-4308

Other identifiers 1

IdentifierTypeStateIssuer
1699030262OtherPANPI TYPE 1

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL jordan.shettle@resilientphysiotherapy.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210421001043 MD Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0143638676 Receives reassigned benefits from 1 practitioner
Practice locations: Rosedale, MD

National Provider Directory

National Provider Directory

Locations

8303 Pulaski Hwy
Baltimore, MD 21237
Phone (717) 817-4308

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565740800000",
    "number": "1528614690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 GREENLEIGH AVE UNIT 515",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212202038",
            "telephone_number": "717-817-4308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8303 PULASKI HWY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212372962",
            "telephone_number": "717-817-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESILIENT PHYSIOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-14",
        "last_updated": "2019-08-14",
        "status": "A",
        "authorized_official_last_name": "SHETTLE",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "DOCTORATE OF PHYSICAL THERAPY",
        "authorized_official_telephone_number": "717-817-4308",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1699030262",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "jordan.shettle@resilientphysiotherapy.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8303 Pulaski Hwy",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212372962",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; 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.