Provider Demographics
NPI:1548559602
Name:CATALYST ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CATALYST ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:443-812-2031
Mailing Address - Street 1:9030 STATE ROUTE 108
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-0000
Mailing Address - Country:US
Mailing Address - Phone:443-812-2031
Mailing Address - Fax:
Practice Address - Street 1:9030 STATE ROUTE 108
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1990
Practice Address - Country:US
Practice Address - Phone:443-812-2031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty