Provider Demographics
NPI:1194685594
Name:SPOONER, GLEN
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:SPOONER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-1504
Mailing Address - Country:US
Mailing Address - Phone:603-863-3260
Mailing Address - Fax:603-863-3291
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1504
Practice Address - Country:US
Practice Address - Phone:603-863-3260
Practice Address - Fax:603-863-3291
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist