Basic Information
| Provider Information | |||||||||
| NPI: | 1073646980 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 360 PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4210 E BASELINE RD | ||||||||
| Address2: | STE 106 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805032373 | ||||||||
| FaxNumber: | 4807825213 | ||||||||
| Practice Location | |||||||||
| Address1: | 4210 E BASELINE RD | ||||||||
| Address2: | STE 106 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805032373 | ||||||||
| FaxNumber: | 4807825213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 08/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | BALDWIN | ||||||||
| AuthorizedOfficialFirstName: | TRESHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER, PT | ||||||||
| AuthorizedOfficialTelephone: | 4808211997 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.