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General NPI Number Information
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NPI Number | 1144797192
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Entity Type | Organization
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Legal Business Name | PONGRATZ ORTHOTICS & PROSTHETICS, INC
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 5750 W THUNDERBIRD RD STE G790
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City | GLENDALE
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State | AZ
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Zip | 85306-4678
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Country | US
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Telephone | 602-395-3354
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Fax |
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Provider Business Mailing Address
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Address Line | 730 N 52ND ST STE 100
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City | PHOENIX
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State | AZ
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Zip | 85008-7987
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Country | US
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Telephone | 602-222-3032
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Fax | 602-222-3506
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH PONGRATZ
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Credential |
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Telephone | 602-222-3032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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