Provider Demographics
NPI:1457435521
Name:RENEHAN, RICHARD J JR (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:RENEHAN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BOEING CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1502
Mailing Address - Country:US
Mailing Address - Phone:410-638-0700
Mailing Address - Fax:
Practice Address - Street 1:2217 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2565
Practice Address - Country:US
Practice Address - Phone:410-638-0700
Practice Address - Fax:410-638-0700
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3716755OtherAETNA HMO
MD7953265OtherAETNA PPO
MD54281809OtherCAREFIRST
MDS2720007OtherCAREFIRST HMO
MDS2720007OtherCAREFIRST HMO