NPIMap

Organization Active NPI

Opal Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Severna Park, MD
National Provider Identifier
1255173183
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
OPAL PHYSICAL THERAPY, LLC
Practice address
770 Ritchie Hwy Ste W23&W24
Severna Park, MD 21146-4149
Phone
(443) 906-1510
Fax
(443) 906-1511
NPI assigned
Jun 11, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Laura Liberatore Tallman, PTNPI 1366468175
Title
Owner/Physical Therapist
Phone
(410) 353-6085

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

770 Ritchie Hwy Ste W23&W24
Severna Park, MD 21146-4149

Mailing address

770 Ritchie Hwy Ste W23&W24
Severna Park, MD 21146-4149
Phone (443) 906-1510

Other names 1

  • Encore Physical Therapy Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250110000756 MD Part B Supplier - Clinic/Group Practice 3375071996 Receives reassigned benefits from 5 practitioners
Practice locations: Annapolis, MD; Severna Park, MD

National Provider Directory

National Provider Directory
Tax ID family
Encore Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

703 Giddings Ave
Ste M1
Annapolis, MD 21401
Phone (443) 837-7560

650 Ritchie Hwy
Ste 309
Severna Park, MD 21146
Phone (410) 353-6085

770 Ritchie Hwy
Ste W24
Severna Park, MD 21146
Phone (443) 906-1510

770 Ritchie Hwy
Ste W23
Severna Park, MD 21146
Phone (443) 906-1510

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758067200000",
    "number": "1255173183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 RITCHIE HWY STE W23&W24",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211464149",
            "telephone_number": "443-906-1510",
            "fax_number": "443-906-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 RITCHIE HWY STE W23&W24",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211464149",
            "telephone_number": "443-906-1510",
            "fax_number": "443-906-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPAL PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-11",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A",
        "authorized_official_last_name": "TALLMAN",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "LIBERATORE",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "410-353-6085",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Encore Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Severna Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.