Provider Demographics
NPI:1306226022
Name:PONGRATZ ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:PONGRATZ ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:INMAN
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:602-222-3032
Mailing Address - Fax:602-222-3506
Practice Address - Street 1:13020 W RANCHO SANTA FE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-2002
Practice Address - Country:US
Practice Address - Phone:623-444-8801
Practice Address - Fax:623-455-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07687929335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier