Provider Demographics
NPI:1407361157
Name:RED CANYON, LLC
Entity Type:Organization
Organization Name:RED CANYON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:IRA
Authorized Official - Last Name:WEISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-833-3025
Mailing Address - Street 1:200 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1230
Mailing Address - Country:US
Mailing Address - Phone:410-833-3025
Mailing Address - Fax:443-522-2129
Practice Address - Street 1:12916 CONAMAR DR STE 103
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2760
Practice Address - Country:US
Practice Address - Phone:304-665-3731
Practice Address - Fax:301-665-3896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED CANYON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-04
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty