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General NPI Number Information
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NPI Number | 1215565957
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Entity Type | Organization
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Legal Business Name | RED CANYON, LLC
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 7402 YORK RD STE 104
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City | TOWSON
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State | MD
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Zip | 21204-7519
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Country | US
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Telephone | 410-716-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 21 CROSS ROADS DRIVE SUITE 330
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City | QWINGS MILLS
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State | MD
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Zip | 21117
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATT ROSEWAG
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Credential |
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Telephone | 410-442-4059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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