Provider Demographics
NPI:1699198481
Name:SPOONER PHYSICAL THERAPY & HAND REHAB, PC
Entity Type:Organization
Organization Name:SPOONER PHYSICAL THERAPY & HAND REHAB, PC
Other - Org Name:SPOONER AVONDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-551-4958
Mailing Address - Street 1:14287 N 87TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3698
Mailing Address - Country:US
Mailing Address - Phone:480-937-1000
Mailing Address - Fax:
Practice Address - Street 1:1585 N 113TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-3938
Practice Address - Country:US
Practice Address - Phone:623-772-7748
Practice Address - Fax:623-772-7749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPOONER PHYSICAL THERAPY & HAND REHAB, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-29
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ324787Medicaid