Healthcare Provider Details

I. General information

NPI: 1265876585
Provider Name (Legal Business Name): SPOONER REHAB, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 W INDIAN SCHOOL RD
AVONDALE AZ
85392-5636
US

IV. Provider business mailing address

9097 E DESERT COVE AVE SUITE 110
SCOTTSDALE AZ
85260-6710
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-7748
  • Fax: 623-772-7749
Mailing address:
  • Phone: 480-860-4298
  • Fax: 480-860-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY A SPOONER
Title or Position: PRESIDENT
Credential: PT
Phone: 480-551-4961