Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lakeside Orthopedic Institute, LLC

Organization Physical Therapist · NPI 1962636050

Lakeside Orthopedic Institute, LLC is a Physical Therapist in Lake Havasu City, Arizona. Licensed in Arizona. Registered with an NPI since 2009.

Licensed in
AZ
In the registry since
2009
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1979 McCulloch Blvd N Ste 101
Lake Havasu City, AZ 86403-0953
Phone: (928) 855-4842
Fax: (928) 855-7452
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 2641 (AZ)
Physical Therapist Taxonomy 225100000X · Licence 8192 (AZ)
Physical Therapist Taxonomy 225100000X · Licence 6762 (AZ)

Record details

NPI number1962636050
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Wesley Johnson — President · 92885455555
NPI enumeratedMay 5, 2009
Last updated in NPPESMay 5, 2009
Mailing address25 Riviera Blvd, Lake Havasu City, AZ 86403-5694

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