Provider Demographics
NPI:1154795110
Name:PHYSICAL THERAPY 360 DEGREES
Entity type:Organization
Organization Name:PHYSICAL THERAPY 360 DEGREES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:770-225-8860
Mailing Address - Street 1:3747 ASHFORD PT NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2114
Mailing Address - Country:US
Mailing Address - Phone:404-202-9787
Mailing Address - Fax:844-965-9428
Practice Address - Street 1:800 MOUNT VERNON HWY NE STE 325
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-225-8860
Practice Address - Fax:844-965-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0063882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty