Provider Demographics
NPI:1669459749
Name:PONGRATZ ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:PONGRATZ ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:INMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
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 1:595 N DOBSON RD
Practice Address - Street 2:SUITE B32
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4226
Practice Address - Country:US
Practice Address - Phone:480-282-4499
Practice Address - Fax:480-615-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ376435Medicaid
AZ1153460004Medicare ID - Type UnspecifiedMESA LOCATION
AZ1153460002Medicare ID - Type UnspecifiedTUCSON LOCATION
AZ1153460001Medicare ID - Type UnspecifiedPHOENIX LOCATION