NPIMap

Organization Active NPI

Northwest Orthopedic & Sports Physical Therapy LLC

  • Orthopedic Physical Therapist
  • Sun City West, AZ
National Provider Identifier
1073610440
Registry record updated Dec 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
Legal business name
NORTHWEST ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC
Practice address
13540 W Camino del Sol Ste 6
Sun City West, AZ 85375-4435
Phone
(623) 556-5013
Fax
(480) 508-5894
NPI assigned
Sep 20, 2006
Last updated
Dec 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lacy La' Nette Wysopal
Title
Managing Member
Phone
(623) 556-5013

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X AZ Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

13540 W Camino del Sol Ste 6
Sun City West, AZ 85375-4435

Mailing address

13540 W Camino del Sol Ste 6
Sun City West, AZ 85375-4435
Phone (623) 556-5013

Other identifiers 1

IdentifierTypeStateIssuer
DF2066OtherAZRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040116000533 AZ Part B Supplier - Clinic/Group Practice 3870494495 Receives reassigned benefits from 3 practitioners
Practice locations: Sun City West, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765497600000",
    "number": "1073610440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13540 W CAMINO DEL SOL STE 6",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853754435",
            "telephone_number": "623-556-5013",
            "fax_number": "480-508-5894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13540 W CAMINO DEL SOL STE 6",
            "city": "SUN CITY WEST",
            "state": "AZ",
            "postal_code": "853754435",
            "telephone_number": "623-556-5013",
            "fax_number": "480-508-5894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2025-12-12",
        "certification_date": "2025-12-12",
        "status": "A",
        "authorized_official_last_name": "WYSOPAL",
        "authorized_official_first_name": "LACY",
        "authorized_official_middle_name": "LA' NETTE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "623-556-5013"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "AZ",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF2066",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun City West, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.