Healthcare Provider Details

I. General information

NPI: 1821464926
Provider Name (Legal Business Name): SPOONER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 N HAYDEN RD SUITE D-333
SCOTTSDALE AZ
85258-3246
US

IV. Provider business mailing address

PO BOX 4570
SCOTTSDALE AZ
85261-4570
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-4967
  • Fax: 480-860-0356
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 State

VIII. Authorized Official

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