MEDICARE: PRO TEAM HEALTH AND WELLNESS, 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	111NS0005X	Sports Physician Chiropractor

General Provider Information

NPI Number	:	1508673393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO TEAM HEALTH AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	4602 N 16TH ST STE 202
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5161
Country	:	US
Telephone Number	:	602-714-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 N 16TH ST STE 202
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5161
Country	:	US
Telephone Number	:	602-714-3690
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DOMINIC BARTOLA
Credential	:
Telephone Number	:	602-558-1427

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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Directions to “PRO TEAM HEALTH AND WELLNESS, LLC ” Practice Location

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