Revive Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

REVIVE PHYSICAL THERAPY LLC

Practice address

4920 Waterloo Rd Ste a
Ellicott City, MD 21043-6888

Phone

(443) 438-0586

Fax

(443) 364-3039

NPI assigned

Jan 28, 2026

Organization subpart

Yes

Parent organization

REVIVE PHYSICAL THERAPY LLCAs reported in NPPES

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

Authorized official

Name

Renuka Jain, DPTNPI 1194924217

Title

Owner

Phone

(781) 266-6621

Specialties & licenses 1

Addresses

Tax ID family

Revive Physical Therapy LLC3 organizations share this tax ID, including this one

Part of

Revive Physical Therapy LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Revive Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Ellicott City, MD
  • NPI 1215204110
  NPD tax ID
• Revive Physical Therapy LLC

  • Physical Therapist
  • Ellicott City, MD
  • NPI 1619827953
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Revive Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Ellicott City, MD
  • NPI 1215204110
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Renuka Jain

  • Physical Therapist
  • Ellicott City, MD
  • NPI 1194924217
  NPD (past) Authorized official

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

{
    "created_epoch": "1769558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769558400000",
    "number": "1679422968",
    "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": "443-438-0586",
            "fax_number": "443-364-3039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 WATERLOO RD STE A",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436888",
            "telephone_number": "443-438-0586",
            "fax_number": "443-364-3039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10300B Baltimore National Pike",
            "address_purpose": "LOCATION",
            "city": "Ellicott City",
            "state": "MD",
            "postal_code": "210422128",
            "country_code": "US",
            "telephone_number": "443-438-0586",
            "fax_number": "443-364-3039",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10316 Baltimore National Pike Ste A",
            "address_purpose": "LOCATION",
            "city": "Ellicott City",
            "state": "MD",
            "postal_code": "210422128",
            "country_code": "US",
            "telephone_number": "443-438-0586",
            "fax_number": "443-364-3039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVE PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REVIVE PHYSICAL THERAPY LLC",
        "enumeration_date": "2026-01-28",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A",
        "authorized_official_last_name": "JAIN",
        "authorized_official_first_name": "RENUKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-266-6621",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patti Lynn Renko, MSW, LCSW-C
• Restorative Counseling and Wellness Center LLC
• Restore Pelvic Physical Therapy
• Revive Physical Therapy LLC
• Revive Physical Therapy LLC
• Angela Reymann, MD
• Kathryn Marie Reynolds, MA, LCPC, NCC, DAPA
• Hyun Rhee, O.M.D.
• Colin John Rhoades, PH.D., LCPC
• Amy Rice

• 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 Jan 28, 2026; 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.