Provider Demographics
NPI:1992199657
Name:360 THERAPY, LLC
Entity Type:Organization
Organization Name:360 THERAPY, LLC
Other - Org Name:360 THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:F
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-209-7140
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-1536
Mailing Address - Country:US
Mailing Address - Phone:225-209-7140
Mailing Address - Fax:225-567-6847
Practice Address - Street 1:19089 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711-3603
Practice Address - Country:US
Practice Address - Phone:225-209-7140
Practice Address - Fax:225-567-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA5108261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy