NPIMap

Organization Active NPI

Lakeside Physical Therapy, Rehab & Sports Medicine

  • Athletic Trainer
  • Lake Havasu City, AZ
National Provider Identifier
1154780633
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
1448 Issued in AZ
Legal business name
LAKESIDE PHYSICAL THERAPY, REHAB & SPORTS MEDICINE
Practice address
25 Riviera Blvd
Lake Havasu City, AZ 86403-5694
Phone
(928) 505-5555
NPI assigned
Feb 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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

Authorized official

Name
Kristina Horton
Title
Office Manager
Phone
(928) 855-4248

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic TrainerGroup: 193200000X MULTI-SPECIALTY GROUP 2255A2300X 1448 AZ Primary

Addresses

Primary practice location

25 Riviera Blvd
Lake Havasu City, AZ 86403-5694

Mailing address

1791 Mesquite Ave
Lake Havasu City, AZ 86403-5648
Phone (928) 855-4248

Other names 1

  • Lakeside Orthopedic Institute Other name

National Provider Directory

National Provider Directory
Tax ID family
Silver State Surgery Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1455235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455235200000",
    "number": "1154780633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1791 MESQUITE AVE",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035648",
            "telephone_number": "928-855-4248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 RIVIERA BLVD",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035694",
            "telephone_number": "928-505-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PHYSICAL THERAPY, REHAB & SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-12",
        "last_updated": "2016-02-12",
        "status": "A",
        "authorized_official_last_name": "HORTON",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "928-855-4248"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "1448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Orthopedic Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.