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General NPI Number Information
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NPI Number | 1710536206
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Entity Type | Organization
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Legal Business Name | 360 REHABILITATION & PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/06/2019
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 9041 MOODY AVENUE
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City | MORTON GROVE
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State | IL
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Zip | 60053
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Country | US
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Telephone | 847-461-3461
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Fax |
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Provider Business Mailing Address
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Address Line | 9114 WAUKEGAN RD UNIT 396
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City | MORTON GROVE
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State | IL
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Zip | 60053-3816
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTINE MAYA
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Credential | PT, DPT
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Telephone | 847-481-9848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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