Provider Demographics
NPI:1518572288
Name:360 THERAPY PARTNERS PLLC
Entity Type:Organization
Organization Name:360 THERAPY PARTNERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:LORENE
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC SLP
Authorized Official - Phone:910-734-5459
Mailing Address - Street 1:726 FULTON ST APT 418
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-6935
Mailing Address - Country:US
Mailing Address - Phone:910-734-5459
Mailing Address - Fax:
Practice Address - Street 1:711 SIGNAL MOUNTAIN RD UNIT 228
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1823
Practice Address - Country:US
Practice Address - Phone:423-498-6546
Practice Address - Fax:423-498-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty