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General NPI Number Information
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NPI Number | 1760349922
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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 | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 7655 WINCHESTER AVENUE STE 2
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City | INWOOD
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State | WV
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Zip | 25428
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Country | US
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Telephone | 304-309-3550
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Fax |
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Provider Business Mailing Address
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Address Line | 7655 WINCHESTER AVENUE STE 2
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City | INWOOD
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State | WV
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Zip | 25428
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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/PT
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Name | MATTHEW T ROSEWAG
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Credential |
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Telephone | 410-730-3399
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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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