| Organization Name: | LAKESIDE ORTHOPEDIC INSTITUTE, LLC |
| NPI Number: | 1962636050 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WESLEY JAMES JOHNSON (PRESIDENT) |
| Mailing Address: | 1979 Mcculloch Blvd N Suite 101 Lake Havasu City |
| State: | AZ US |
| Postal Code: | 864030953 |
| Phone Number: | 9288554842 |
| Fax Number: | 9288557452 |
| NPI Enumeration Date: | 05/05/2009 |
| NPI Last Update Date: | 05/05/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 8192 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |