Provider Demographics
NPI:1932430949
Name:360 PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:360 PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNNEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-821-1997
Mailing Address - Street 1:8670 E SHEA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6656
Mailing Address - Country:US
Mailing Address - Phone:480-607-9200
Mailing Address - Fax:480-607-9207
Practice Address - Street 1:8670 E SHEA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6656
Practice Address - Country:US
Practice Address - Phone:480-607-9200
Practice Address - Fax:480-607-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2021-09-09
Deactivation Date:2021-08-26
Deactivation Code:
Reactivation Date:2021-09-09
Provider Licenses
StateLicense IDTaxonomies
AZ5497174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ616922Medicaid
AZ66833OtherMEDICARE IDENITIFCATION NUMBER