Healthcare Provider Details

I. General information

NPI: 1275576589
Provider Name (Legal Business Name): 360 PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 W CHANDLER BLVD STE 103
CHANDLER AZ
85224-5225
US

IV. Provider business mailing address

1076 W CHANDLER BLVD STE 103
CHANDLER AZ
85224-5223
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-1997
  • Fax: 480-821-1887
Mailing address:
  • Phone: 480-821-1997
  • Fax: 480-821-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT PACE
Title or Position: OWNER
Credential:
Phone: 213-804-1712