Healthcare Provider Details

I. General information

NPI: 1609183177
Provider Name (Legal Business Name): PT 360 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 INDUSTRIAL AVE SUITE 190
WILLISTON VT
05495-4448
US

IV. Provider business mailing address

426 INDUSTRIAL AVE SUITE 190
WILLISTON VT
05495-7904
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-4360
  • Fax: 802-488-3160
Mailing address:
  • Phone: 802-860-4360
  • Fax: 802-488-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number040-0002463
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number104-0000042
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040-0002123
License Number StateVT

VIII. Authorized Official

Name: MS. MARY CASEY STEIGER
Title or Position: BOARD OF DIRECTORS - PRESIDENT
Credential: PHYSICAL THERAPIST
Phone: 802-860-4360