1669889911 NPI number — SPOONER PHYSICAL THERAPY & HAND REHAB, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669889911 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:
1669889911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2025
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:
480-937-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4955 S ALMA SCHOOL RD STE 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85248-5640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-802-7081
Provider Business Practice Location Address Fax Number:
480-802-8492
Provider Enumeration Date:
07/18/2014

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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