Basic Information
| Provider Information | |||||||||
| NPI: | 1154728350 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 360 PHYSICAL THERAPY, LLC | ||||||||
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| OtherOrganizationName: | 360 PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21083 N JOHN WAYNE PKWY | ||||||||
| Address2: | C103/C104 | ||||||||
| City: | MARICOPA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851392959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808211997 | ||||||||
| FaxNumber: | 4808211887 | ||||||||
| Practice Location | |||||||||
| Address1: | 21083 N JOHN WAYNE PKWY | ||||||||
| Address2: | C103/C104 | ||||||||
| City: | MARICOPA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851392959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808211997 | ||||||||
| FaxNumber: | 4808211887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2014 | ||||||||
| LastUpdateDate: | 12/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | BRUNIN | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMIN OPERATIONS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4808211997 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.