Provider Demographics
NPI:1508673393
Name:PRO TEAM HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:PRO TEAM HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-558-1427
Mailing Address - Street 1:4602 N 16TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5161
Mailing Address - Country:US
Mailing Address - Phone:602-714-3690
Mailing Address - Fax:
Practice Address - Street 1:4602 N 16TH ST STE 202
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5161
Practice Address - Country:US
Practice Address - Phone:602-714-3690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty