=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801597588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUTTING EDGE PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2023
-----------------------------------------------------
Last Update Date | 03/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9505 BERGER RD STE 200
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21046-2583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-956-8608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3746 GREENWAY LN
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-1418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-956-8608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JARED GOLDSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-956-8608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------