MEDICARE: CUTTING EDGE PHYSICAL THERAPY

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1801597588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTTING EDGE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	3746 GREENWAY LN
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-1418
Country	:	US
Telephone Number	:	443-956-8608
Fax Number	:

Provider Business Practice Location Address
First Line	:	9505 BERGER RD STE 200
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-2583
Country	:	US
Telephone Number	:	443-956-8608
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JARED GOLDSTEIN
Credential	:
Telephone Number	:	443-956-8608

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	03/10/2023

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