MEDICARE: STEVEN L. SPOONEMORE JR. PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1168180	TX
2	2251X0800X	Orthopedic Physical Therapist	137405	AK

General Provider Information

NPI Number	:	1548496656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN L. SPOONEMORE JR. PT

Provider Business Mailing Address
First Line	:	7092 HARR AVE
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80902-2190
Country	:	US
Telephone Number	:	719-524-5217
Fax Number	:

Provider Business Practice Location Address
First Line	:	7092 HARR AVE
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80902-2190
Country	:	US
Telephone Number	:	719-524-5217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	08/05/2025

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