Provider Demographics
NPI:1760944433
Name:SPOONER PHYSICAL THERAPY & HAND REHAB PC
Entity Type:Organization
Organization Name:SPOONER PHYSICAL THERAPY & HAND REHAB PC
Other - Org Name:SPOONER MCCORMICK RANCH
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 1:9097 E DESERT COVE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:602-329-8250
Mailing Address - Fax:480-565-1898
Practice Address - Street 1:8415 N PIMA RD STE 165
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4486
Practice Address - Country:US
Practice Address - Phone:480-909-4777
Practice Address - Fax:480-909-4778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPOONER PHYSICAL THERAPY & HAND REHAB, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-02
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ324787Medicaid