Healthcare Provider Details

I. General information

NPI: 1760300396
Provider Name (Legal Business Name): RYAN THOMAS LUNSFORD PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12740 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-8100
US

IV. Provider business mailing address

9550 W NORTHERN AVE UNIT 2129
PEORIA AZ
85345-0008
US

V. Phone/Fax

Practice location:
  • Phone: 480-581-3600
  • Fax:
Mailing address:
  • Phone: 260-433-8567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034861
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: