Provider Demographics
NPI:1154806065
Name:360 PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:360 PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF BILLING OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNNEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-821-1997
Mailing Address - Street 1:1076 W CHANDLER BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5223
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:480-821-2536
Practice Address - Street 1:10861 E BASELINE RD STE A-105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-7921
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:480-821-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty