Healthcare Provider Details

I. General information

NPI: 1467837914
Provider Name (Legal Business Name): SPOONER PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9097 E DESERT COVE AVE SUITE 110
SCOTTSDALE AZ
85260-6279
US

IV. Provider business mailing address

9097 E DESERT COVE AVE SUITE 110
SCOTTSDALE AZ
85260-6279
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-4961
  • Fax:
Mailing address:
  • Phone: 480-551-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11579
License Number StateAZ

VIII. Authorized Official

Name: TERESA YENSER
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 480-551-4967