Healthcare Provider Details

I. General information

NPI: 1295110120
Provider Name (Legal Business Name): 363 THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N COMMERCE PKWY STE 200
WESTON FL
33326-3258
US

IV. Provider business mailing address

2200 N COMMERCE PKWY STE 200
WESTON FL
33326-3258
US

V. Phone/Fax

Practice location:
  • Phone: 954-805-4509
  • Fax: 954-827-0452
Mailing address:
  • Phone: 954-805-4509
  • Fax: 954-827-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12275
License Number StateFL

VIII. Authorized Official

Name: ANDREA SANTIAGO
Title or Position: OWNER
Credential:
Phone: 954-805-4509