MEDICARE: RICHARD J RENEHAN JR. P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	16902	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3716755	OTHER	MD	AETNA HMO
2	7953265	OTHER	MD	AETNA PPO
3	54281809	OTHER	MD	CAREFIRST
4	S2720007	OTHER	MD	CAREFIRST HMO

General Provider Information

NPI Number	:	1457435521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J RENEHAN JR. P.T.

Provider Business Mailing Address
First Line	:	310 BOEING CT
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1502
Country	:	US
Telephone Number	:	410-638-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2217 COMMERCE RD
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-2565
Country	:	US
Telephone Number	:	410-638-0700
Fax Number	:	410-638-0700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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