MEDICARE: RED CANYON, LLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1366007338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED CANYON, LLC

Provider Business Mailing Address
First Line	:	200 BUSINESS CENTER DR
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-1230
Country	:	US
Telephone Number	:	240-575-9260
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 KNOLL NORTH DR STE 230
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2362
Country	:	US
Telephone Number	:	240-575-9260
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL JAMES GARDNER
Credential	:
Telephone Number	:	443-416-7949

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	04/23/2021

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Directions to “RED CANYON, LLC ” Practice Location

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