MEDICARE: 360 PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1811153992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	360 PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	12545 N SAGUARO BLVD
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-3857
Country	:	US
Telephone Number	:	480-837-1530
Fax Number	:	480-821-1887

Provider Business Practice Location Address
First Line	:	12545 N SAGUARO BLVD
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-3857
Country	:	US
Telephone Number	:	480-837-1530
Fax Number	:	480-821-1887

Authorized Official
Title or Position	:	ADMINSTRATIVE OPERATIONS
Name	:	MRS. CHERYL BRUNIN
Credential	:
Telephone Number	:	480-821-1997

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	09/09/2013

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