Healthcare Provider Details

I. General information

NPI: 1235874348
Provider Name (Legal Business Name): PONGRATZ ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10133 N 92ND ST STE 102
SCOTTSDALE AZ
85258-4556
US

IV. Provider business mailing address

730 N 52ND ST STE 100
PHOENIX AZ
85008-7987
US

V. Phone/Fax

Practice location:
  • Phone: 480-791-2999
  • Fax: 480-702-0466
Mailing address:
  • Phone: 602-222-3032
  • Fax: 602-222-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE INMAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 602-222-3032