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General NPI Number Information
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NPI Number | 1992447304
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Entity Type | Organization
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Legal Business Name | 360 PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 04/07/2022
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 3530 S VAL VISTA DR STE 102
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City | GILBERT
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State | AZ
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Zip | 85297-7319
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Country | US
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Telephone | 408-726-1818
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Fax | 408-726-2798
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Provider Business Mailing Address
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Address Line | 1076 W CHANDLER BLVD STE 103
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City | CHANDLER
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State | AZ
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Zip | 85224-5223
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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 AND COO
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Name | ROBERT PACE
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Credential |
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Telephone | 213-804-1712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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