Provider Demographics
NPI:1134134836
Name:SPOONER, JUSTIN LONN (LPT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:LONN
Last Name:SPOONER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5141
Mailing Address - Country:US
Mailing Address - Phone:772-343-8000
Mailing Address - Fax:772-343-7999
Practice Address - Street 1:621 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5141
Practice Address - Country:US
Practice Address - Phone:772-343-8000
Practice Address - Fax:772-343-7999
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT2055OtherLICENSE #