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
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