Individual provider Active NPI

Alta Rebekah Gillin, PT, DPT

  • Physical Therapist
  • Glen Burnie, MD
National Provider Identifier
1720524796
Registry record updated Jun 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
1406 Crain Hwy S Ste 110
Glen Burnie, MD 21061
Phone
(410) 762-2124
Fax
(410) 705-5057
NPI assigned
Jan 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2018

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 MD Primary

Addresses

Primary practice location

1406 Crain Hwy S Ste 110
Glen Burnie, MD 21061

Mailing address

1406 Crain Hwy S Ste 110
Glen Burnie, MD 21061-4086
Phone (410) 762-2124

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180504000248 MD Practitioner - Physical Therapist in Private Practice 1355605031 Reassigns benefits to 1 organization
I20251122000789 DC Practitioner - Physical Therapist in Private Practice 1355605031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Rehab PT MD LLCGroup PAC ID 6709028822, 92 clinicians

Practice addresses (Care Compare)

6451 N Charles St
Baltimore, MD 21212-1010
Phone (877) 407-3422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Rehab PT MD LLC Physical Therapist CurrentSince Aug 1, 2022 Accepting new patients
Fox Rehabilitation Services LLC Physical Therapist CurrentSince Oct 1, 2025 Accepting new patients

Locations

11665 Doolittle Dr
Waldorf, MD 20602
Phone (301) 638-4100

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": "1484265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527897600000",
    "number": "1720524796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 CRAIN HWY S STE 110",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614086",
            "telephone_number": "410-762-2124",
            "fax_number": "410-705-5057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 CRAIN HWY S STE 110",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "21061",
            "telephone_number": "410-762-2124",
            "fax_number": "410-705-5057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIN",
        "first_name": "ALTA",
        "middle_name": "REBEKAH",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-13",
        "last_updated": "2018-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2018; 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.