Healthcare Provider Details

I. General information

NPI: 1184762890
Provider Name (Legal Business Name): PENTZ HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 E SUPERSTITION SPRINGS BLVD STE 123
MESA AZ
85206-4391
US

IV. Provider business mailing address

6402 E SUPERSTITION SPRINGS BLVD STE 123
MESA AZ
85206-4391
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-0302
  • Fax: 480-494-5770
Mailing address:
  • Phone: 480-833-0302
  • Fax: 480-494-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5115
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP4770
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6001
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8169
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8671
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number5900
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6903
License Number StateAZ

VIII. Authorized Official

Name: CODY REED
Title or Position: CIO
Credential:
Phone: 480-833-0302