Provider Demographics
NPI:1154728350
Name:360 PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:360 PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-821-1997
Mailing Address - Street 1:21083 N JOHN WAYNE PKWY
Mailing Address - Street 2:C103/C104
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-2959
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:480-821-1887
Practice Address - Street 1:21083 N JOHN WAYNE PKWY
Practice Address - Street 2:C103/C104
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2959
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:480-821-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty