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General NPI Number Information
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NPI Number | 1508673393
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Entity Type | Organization
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Legal Business Name | PRO TEAM HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 4602 N 16TH ST STE 202
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City | PHOENIX
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State | AZ
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Zip | 85016-5161
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Country | US
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Telephone | 602-714-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 4602 N 16TH ST STE 202
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City | PHOENIX
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State | AZ
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Zip | 85016-5161
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Country | US
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Telephone | 602-714-3690
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DOMINIC BARTOLA
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Credential |
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Telephone | 602-558-1427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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