Provider Demographics
NPI:1528011053
Name:SPOONER, TIMOTHY A (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:SPOONER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6279
Mailing Address - Country:US
Mailing Address - Phone:480-860-4298
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:9097 E DESERT COVE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6279
Practice Address - Country:US
Practice Address - Phone:480-860-4298
Practice Address - Fax:480-860-0356
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ250006310OtherRAILROAD MEDICARE PTAN
AZ27079Medicare ID - Type Unspecified