NPIMap

Organization Active NPI

Red Canyon, LLC

  • Physical Therapy Clinic/Center
  • Columbia, MD
National Provider Identifier
1366007338
Registry record updated Apr 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
RED CANYON, LLC
Practice address
5500 Knoll North Dr Ste 230
Columbia, MD 21045-2362
Phone
(240) 575-9260
NPI assigned
May 6, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2021

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

Authorized official

Name
Daniel James Gardner
Title
Owner
Phone
(443) 416-7949

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

5500 Knoll North Dr Ste 230
Columbia, MD 21045-2362

Mailing address

200 Business Center Dr
Reisterstown, MD 21136-1230
Phone (240) 575-9260

Other names 1

  • Red Canyon Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160331002359 MD Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1052618352 Receives reassigned benefits from 17 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Columbia, MD; Frederick, MD; Hagerstown, MD; Urbana, MD

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Red Canyon LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1557100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619136000000",
    "number": "1366007338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BUSINESS CENTER DR",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211361230",
            "telephone_number": "240-575-9260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 KNOLL NORTH DR STE 230",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452362",
            "telephone_number": "240-575-9260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED CANYON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-06",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-416-7949"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Canyon Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; 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.