Provider Demographics
NPI:1134696180
Name:PONGRATZ ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:PONGRATZ ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PONGRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-222-3032
Mailing Address - Street 1:730 N 52ND ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7987
Mailing Address - Country:US
Mailing Address - Phone:602-628-2888
Mailing Address - Fax:
Practice Address - Street 1:1450 S DOBSON RD STE B326
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4749
Practice Address - Country:US
Practice Address - Phone:602-395-3354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies