Provider Demographics
NPI:1104478320
Name:SPOONER PHYSICAL THERAPY & HAND REHAB, PC
Entity type:Organization
Organization Name:SPOONER PHYSICAL THERAPY & HAND REHAB, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-551-4958
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:480-909-4930
Mailing Address - Fax:480-909-4931
Practice Address - Street 1:7555 E OSBORN RD STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6442
Practice Address - Country:US
Practice Address - Phone:480-909-4930
Practice Address - Fax:480-909-4931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ324787Medicaid