Provider Demographics
NPI:1922513027
Name:SPOONER, JASON RANDALL (PT, DPT, RN)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:RANDALL
Last Name:SPOONER
Suffix:
Gender:M
Credentials:PT, DPT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 NEWBERRY STATION DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-3984
Mailing Address - Country:US
Mailing Address - Phone:337-302-9034
Mailing Address - Fax:
Practice Address - Street 1:4112 LAKE ST STE 600
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4306
Practice Address - Country:US
Practice Address - Phone:337-304-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09016R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist