# ACTIVE 360 THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174349575
- **Authorized official:** CALISTA CHANA (CEO)
- **Authorized official phone:** (301) 776-8103

## Contact information

- **Practice address:** 6212 YORK RD, BALTIMORE, MD 21212-2612
- **Practice address phone:** (301) 776-8103
- **Practice address fax:** (410) 755-7797
- **Mailing address:** 6801 OAK HALL LN UNIT 6462, COLUMBIA, MD 21045-7587
- **Mailing address phone:** (301) 776-8103
- **Mailing address fax:** (410) 755-7797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 163WH0200X | Home Health Registered Nurse | — | NULL | — |
| 163WH0200X | Home Health Registered Nurse | — | — | — |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 251E00000X | Home Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 12/02/2024
- **Last updated:** 10/10/2025