Provider Demographics
NPI:1336010784
Name:OPAL PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:OPAL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-721-7201
Mailing Address - Street 1:770 RITCHIE HWY STE W23&W24
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4149
Mailing Address - Country:US
Mailing Address - Phone:443-906-1510
Mailing Address - Fax:443-906-1511
Practice Address - Street 1:703 GIDDINGS AVE STE M1
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1411
Practice Address - Country:US
Practice Address - Phone:443-906-1510
Practice Address - Fax:443-906-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy