Provider Demographics
NPI:1689115164
Name:360 PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:360 PHYSICAL THERAPY LLC
Other - Org Name:360 PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE PROCESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-821-1997
Mailing Address - Street 1:21576 S ELLSWORTH LOOP RD
Mailing Address - Street 2:150
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:480-782-5213
Practice Address - Street 1:21576 S ELLSWORTH LOOP RD
Practice Address - Street 2:150
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:480-782-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty