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General NPI Number Information
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NPI Number | 1447773825
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Entity Type | Organization
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Legal Business Name | 360 WELLNESS SOLUTIONS, LLC
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 194 LOCH LOMOND RD
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-5600
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Country | US
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Telephone | 760-832-8025
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Fax | 760-764-4010
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Provider Business Mailing Address
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Address Line | 194 LOCH LOMOND RD
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-5600
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Country | US
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Telephone | 760-832-8025
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Fax | 760-764-4010
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHERINE JOSEPHINE SULLIVAN
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Credential | PHD, PT
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Telephone | 760-832-8025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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