1124530092 NPI number — SPOONER PHYSICAL THERAPY & HAND REHAB, PC

Table of content: (NPI 1124530092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124530092 NPI number — SPOONER PHYSICAL THERAPY & HAND REHAB, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPOONER PHYSICAL THERAPY & HAND REHAB, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124530092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14287 N 87TH ST STE 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-3698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-219-4600
Provider Business Mailing Address Fax Number:
623-219-4601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5215 W BASELINE RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAVEEN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85339-2943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-551-4966
Provider Business Practice Location Address Fax Number:
480-247-8499
Provider Enumeration Date:
10/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SPOONER
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-551-4958

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 324787 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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