Basic Information
| Provider Information | |||||||||
| NPI: | 1366957904 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPOONER LAVEEN, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9097 E DESERT COVE AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805514967 | ||||||||
| FaxNumber: | 4808600356 | ||||||||
| Practice Location | |||||||||
| Address1: | 5215 W BASELINE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | LAVEEN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853392943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232194600 | ||||||||
| FaxNumber: | 6232194601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2017 | ||||||||
| LastUpdateDate: | 12/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | SPOONER | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4805514958 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.