Organization
REVIVE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RENUKA JAIN DPT, COMT (OWNER/PHYSICAL THERAPIST)
(443) 364-4495
Entity
Organization
Contact information
Practice address
10300 BALTIMORE NATIONAL PIKE, UNIT #B, ELLICOTT CITY, MD 21042-2128
(443) 364-4495
Mailing address
10300 BALTIMORE NATIONAL PIKE, UNIT #B, ELLICOTT CITY, MD 21042-2128
(443) 364-4495
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
22176
MD
Other
Enumeration date
11/20/2011
Last updated
11/20/2011
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