Healthcare Provider Details

I. General information

NPI: 1366957904
Provider Name (Legal Business Name): SPOONER LAVEEN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 W BASELINE RD STE 101
LAVEEN AZ
85339-2943
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 110
SCOTTSDALE AZ
85260-6276
US

V. Phone/Fax

Practice location:
  • Phone: 623-219-4600
  • Fax: 623-219-4601
Mailing address:
  • Phone: 480-551-4967
  • Fax: 480-860-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: TIMOTHY SPOONER
Title or Position: PRESIDENT
Credential: PT
Phone: 480-551-4958