{
"Npi": {
"NPI": "1114768678",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "SPOONER PHYSICAL THERAPY & HAND REHAB PC",
"ParentOrgTIN": null,
"OrgName": "SPOONER PHYSICAL THERAPY & HAND REHAB PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "14287 N 87TH ST STE 220",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SCOTTSDALE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85260-3698",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-212-1040",
"MailingAddressFaxNumber": "623-212-1041",
"FirstLinePracticeLocationAddress": "865 S WATSON RD STE 118",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BUCKEYE",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85326-3468",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "623-212-1040",
"PracticeLocationAddressFaxNumber": "623-212-1041",
"EnumerationDate": "06/06/2024",
"LastUpdateDate": "04/30/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEYER",
"AuthorizedOfficialFirstName": "LYNDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR OF RCM",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "480-551-4967",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}