Basic Information
| Provider Information | |||||||||
| NPI: | 1255693289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPOONER PHYSICAL THERAPY & HAND REHAB PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9097 E DESERT COVE AVE | ||||||||
| Address2: | STE 110 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808604298 | ||||||||
| FaxNumber: | 4808600356 | ||||||||
| Practice Location | |||||||||
| Address1: | 16515 S 40TH ST | ||||||||
| Address2: | STE 119 B | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022249891 | ||||||||
| FaxNumber: | 6022249808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2012 | ||||||||
| LastUpdateDate: | 04/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | SPOONER | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4808604298 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SPOONER PHYSICAL THERAPY & HAND REHAB PC | ||||||||
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| AuthorizedOfficialCredential: | PT, FAFS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.