Healthcare Provider Details

I. General information

NPI: 1154806065
Provider Name (Legal Business Name): 360 PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 E BASELINE RD STE A-105
MESA AZ
85209-7921
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: 480-821-2536
Mailing address:
  • Phone: 480-821-1997
  • Fax: 480-821-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHERYL HUNNEL
Title or Position: VP OF BILLING OPERATIONS
Credential:
Phone: 480-821-1997