Organization
PONGRATZ PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANISSA L PONGRATZ MPT (PRESIDENT/OWNER)
(602) 222-3032
Entity
Organization
Contact information
Practice address
641 W SOUTHERN AVE, MESA, AZ 85210-5004
(602) 222-3032
(480) 615-1117
Mailing address
641 W SOUTHERN AVE, MESA, AZ 85210-5004
(602) 222-3032
(480) 615-1117
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5241
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81712
MEDICARE GROUP PIN
AZ
05
—
864399
—
AZ
Enumeration date
12/11/2007
Last updated
12/11/2007
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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