Provider Demographics
NPI:1083038251
Name:SPOONER, BRIDGET (ATC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:SPOONER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 BRADFIELD DR APT 42
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-9674
Mailing Address - Country:US
Mailing Address - Phone:315-854-4296
Mailing Address - Fax:
Practice Address - Street 1:1 ALPHA DR
Practice Address - Street 2:ATHLETICS SPORTS MEDICINE
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2298
Practice Address - Country:US
Practice Address - Phone:717-361-1591
Practice Address - Fax:717-361-1135
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0056202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer