Healthcare Provider Details

I. General information

NPI: 1659080281
Provider Name (Legal Business Name): 360 BALANCE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NEWBURY ST UNIT 607
BOSTON MA
02116-2912
US

IV. Provider business mailing address

137 NEWBURY ST UNIT 607
BOSTON MA
02116-2912
US

V. Phone/Fax

Practice location:
  • Phone: 857-207-8675
  • Fax:
Mailing address:
  • Phone: 857-207-8675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINA HUDSON
Title or Position: MANAGING MEMBER
Credential: PT,DPT
Phone: 857-207-8675