MEDICARE: 360 PT AND WELLNESS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	175L00000X	Homeopath
3	225200000X	Physical Therapy Assistant
4	225700000X	Massage Therapist
5	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1750997037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	360 PT AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	4324 MAPLESHADE LN STE 156
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-0050
Country	:	US
Telephone Number	:	708-415-4386
Fax Number	:	214-736-1190

Provider Business Practice Location Address
First Line	:	4324 MAPLESHADE LN STE 156
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-0050
Country	:	US
Telephone Number	:	214-659-1683
Fax Number	:	214-736-1190

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. DANIELLE L BAILEY
Credential	:	PT, DPT
Telephone Number	:	708-415-4386

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	12/06/2024

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