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General NPI Number Information
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NPI Number | 1073610440
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Entity Type | Organization
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Legal Business Name | NORTHWEST ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 13540 W CAMINO DEL SOL STE 6
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-4435
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Country | US
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Telephone | 623-556-5013
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Fax | 480-508-5894
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Provider Business Mailing Address
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Address Line | 13540 W CAMINO DEL SOL STE 6
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-4435
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Country | US
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Telephone | 623-556-5013
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Fax | 480-508-5894
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LACY LA' NETTE WYSOPAL
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Credential |
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Telephone | 623-556-5013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State | AZ
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