Healthcare Provider Details

I. General information

NPI: 1184465650
Provider Name (Legal Business Name): SPOONER PHYSICAL THERAPY AND HAND REHAB, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 FIT SPORT LIFE BLVD STE 102
ROCKWALL TX
75032-6928
US

IV. Provider business mailing address

PO BOX 4570
SCOTTSDALE AZ
85261-4570
US

V. Phone/Fax

Practice location:
  • Phone: 945-305-4001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: LYNDA MEYER
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 480-551-4967