NPIMap

Organization Active NPI

360 Physical Therapy, LLC

  • Physical Therapist
  • Maricopa, AZ
National Provider Identifier
1154728350
Registry record updated Dec 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
360 PHYSICAL THERAPY, LLC
Practice address
21083 N John Wayne Pkwy
C103/C104
Maricopa, AZ 85139-2959
Phone
(480) 821-1997
Fax
(480) 821-1887
NPI assigned
Dec 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cheryl Brunin
Title
Admin Operations Director
Phone
(480) 821-1997

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

21083 N John Wayne Pkwy
C103/C104
Maricopa, AZ 85139-2959

Mailing address

21083 N John Wayne Pkwy
C103/C104
Maricopa, AZ 85139-2959
Phone (480) 821-1997

Other names 1

  • 360 Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040224000822 AZ Part B Supplier - Clinic/Group Practice 1355237645 Receives reassigned benefits from 144 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ; Queen Creek, AZ; Scottsdale, AZ; Sun Lakes, AZ; Surprise, AZ; Tempe, AZ; Goodyear, AZ; Mesa, AZ…

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
360 Physical Therapy LLC15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

21083 N John Wayne Pkwy
#C103C104
Maricopa, AZ 85139

14202 N Scottsdale Rd
Ste 169
Scottsdale, AZ 85254
Phone (480) 265-2122

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417564800000",
    "number": "1154728350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21083 N JOHN WAYNE PKWY",
            "address_2": "C103/C104",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851392959",
            "telephone_number": "480-821-1997",
            "fax_number": "480-821-1887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21083 N JOHN WAYNE PKWY",
            "address_2": "C103/C104",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851392959",
            "telephone_number": "480-821-1997",
            "fax_number": "480-821-1887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "360 PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2014-12-03",
        "status": "A",
        "authorized_official_last_name": "BRUNIN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "ADMIN OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "480-821-1997"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "360 Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maricopa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.