MEDICARE: SPOONER PHYSICAL THERAPY & HAND REHAB, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205288024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOONER PHYSICAL THERAPY & HAND REHAB, PC

Provider Business Mailing Address
First Line	:	9097 E DESERT COVE AVE STE 110
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-6276
Country	:	US
Telephone Number	:	480-502-5361
Fax Number	:	480-502-5369

Provider Business Practice Location Address
First Line	:	15255 N 40TH ST STE 123
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4638
Country	:	US
Telephone Number	:	480-502-5361
Fax Number	:	480-502-5369

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY A SPOONER
Credential	:	PT
Telephone Number	:	480-551-4958

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	02/19/2025

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