Provider Demographics
NPI:1548496656
Name:SPOONEMORE, STEVEN L JR (PT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:SPOONEMORE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7092 HARR AVE
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80902-2190
Mailing Address - Country:US
Mailing Address - Phone:719-524-5217
Mailing Address - Fax:
Practice Address - Street 1:7092 HARR AVE
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80902-2190
Practice Address - Country:US
Practice Address - Phone:719-524-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1374052251X0800X
TX1168180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
320059Medicare Oscar/Certification