Provider Demographics
NPI:1194814137
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:
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 #110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:602-437-5055
Mailing Address - Fax:602-437-5395
Practice Address - Street 1:5750 S. 32ND STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040
Practice Address - Country:US
Practice Address - Phone:602-437-5055
Practice Address - Fax:602-437-5395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPOONER PHYSICAL THERAPY & HAND REHAB, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2667261QP2000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860908199OtherTAX ID