Organization
360 REHAB SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAINIELLE GORDON-CORNWALL DPT (PRESIDENT/OWNER)
(954) 648-5565
Entity
Organization
Contact information
Practice address
12251 TAFT ST, PEMBROKE PINES, FL 33026-1901
(954) 648-5565
Mailing address
12251 TAFT ST, PEMBROKE PINES, FL 33026-1901
(954) 648-5565
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT25081
PT LICENSE
FL
Enumeration date
06/04/2019
Last updated
08/19/2019
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