MEDICARE: CATALYST ORTHOPEDIC & SPORTS PHYSICAL THERAPY 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	225100000X	Physical Therapist	21596	MD

General Provider Information

NPI Number	:	1548559602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATALYST ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	9030 STATE ROUTE 108
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-0000
Country	:	US
Telephone Number	:	443-812-2031
Fax Number	:

Provider Business Practice Location Address
First Line	:	9030 STATE ROUTE 108
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1990
Country	:	US
Telephone Number	:	443-812-2031
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	JASON ANDREW NUNN
Credential	:	DPT
Telephone Number	:	443-812-2031

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	03/29/2011

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Directions to “CATALYST ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC ” Practice Location

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