Basic Information
| Provider Information | |||||||||
| NPI: | 1811153992 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 360 PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12545 N SAGUARO BLVD | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILLS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852683857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808371530 | ||||||||
| FaxNumber: | 4808211887 | ||||||||
| Practice Location | |||||||||
| Address1: | 12545 N SAGUARO BLVD | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILLS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852683857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808371530 | ||||||||
| FaxNumber: | 4808211887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | BRUNIN | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINSTRATIVE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4808211997 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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.