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General NPI Number Information
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NPI Number | 1508502204
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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 | 05/06/2022
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 3501 JOHN SIMMONS ST # A203
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City | URBANA
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State | MD
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Zip | 21704-7964
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Country | US
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Telephone | 301-882-8382
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Fax | 301-882-8399
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Provider Business Mailing Address
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Address Line | 3501 JOHN SIMMONS ST # A203
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City | URBANA
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State | MD
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Zip | 21704-7964
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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 | DANIEL JAMES GARDNER
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Credential |
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Telephone | 443-416-7949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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