Lasting Roots Pediatric Physical Therapy, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

LASTING ROOTS PEDIATRIC PHYSICAL THERAPY, PLLC

Practice address

8980 Bardwell LN
Village of Lakewood, IL 60014-6865

Phone

(319) 651-7717

NPI assigned

Oct 15, 2026

Last updated

Oct 15, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Allyson Wennlund, PT

Title

Physical Therapist

Phone

(319) 651-7717

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1792022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792022400000",
    "number": "1164328464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8980 BARDWELL LN",
            "city": "VILLAGE OF LAKEWOOD",
            "state": "IL",
            "postal_code": "600146865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8980 BARDWELL LN",
            "city": "VILLAGE OF LAKEWOOD",
            "state": "IL",
            "postal_code": "600146865",
            "telephone_number": "319-651-7717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASTING ROOTS PEDIATRIC PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-15",
        "last_updated": "2026-10-15",
        "certification_date": "2026-10-15",
        "status": "A",
        "authorized_official_last_name": "WENNLUND",
        "authorized_official_first_name": "ALLYSON",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "319-651-7717",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Village of Lakewood, IL
• Providers in Village of Lakewood, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.