MEDICARE: PENTZ HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6001	AZ
2	363A00000X	Physician Assistant	5115	AZ
3	363L00000X	Nurse Practitioner	AP4770	AZ
4	111N00000X	Chiropractor	8169	AZ
5	111N00000X	Chiropractor	8671	AZ
6	225100000X	Physical Therapist	6903	AZ
7	111NS0005X	Sports Physician Chiropractor	5900	AZ

General Provider Information

NPI Number	:	1184762890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENTZ HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	6402 E SUPERSTITION SPRINGS BLVD STE 123
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4391
Country	:	US
Telephone Number	:	480-833-0302
Fax Number	:	480-494-5770

Provider Business Practice Location Address
First Line	:	6402 E SUPERSTITION SPRINGS BLVD STE 123
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4391
Country	:	US
Telephone Number	:	480-833-0302
Fax Number	:	480-494-5770

Authorized Official
Title or Position	:	CIO
Name	:	CODY REED
Credential	:
Telephone Number	:	480-833-0302

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/21/2022

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Directions to “PENTZ HEALTH SERVICES LLC ” Practice Location

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