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General NPI Number Information
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NPI Number | 1306226022
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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 | 06/08/2015
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 13020 W RANCHO SANTA FE BLVD STE 101
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City | AVONDALE
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State | AZ
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Zip | 85392-2002
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Country | US
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Telephone | 623-444-8801
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Fax | 623-455-3776
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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 | OPERATIONS MANAGER
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Name | NICHOLE INMAN
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 07687929
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License Number State | AZ
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