Lakeside Physical Therapy and Wellness LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

LAKESIDE PHYSICAL THERAPY AND WELLNESS LLC

Practice address

12109 Iroquois Rd
Conneaut Lake, PA 16316-3341

Phone

(814) 382-9405

NPI assigned

Dec 16, 2019

Organization subpart

No

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

Authorized official

Name

Mark LeonardNPI 1033403621

Title

Owner

Phone

(814) 573-1549

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark J Leonard, P.T., D.P.T.

  • Physical Therapist
  • Conneaut Lake, PA
  • NPI 1033403621
  Medicare reassignment Care Compare group NPD Authorized official
• Danny Leonard McCullough, MPT

  • Physical Therapist
  • Port St Lucie, FL
  • NPI 1942387295

  PA

  Medicare reassignment Care Compare group NPD
• Alyse Ann Widger, DPT

  • Physical Therapist
  • Meadville, PA
  • NPI 1104198431
  Medicare reassignment Care Compare group
• Kelsy Marie Hill, DPT

  • Physical Therapist
  • Conshohocken, PA
  • NPI 1396400750
  Medicare reassignment

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

{
    "created_epoch": "1576454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1689212136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12109 IROQUOIS RD",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163163341",
            "telephone_number": "814-382-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12109 IROQUOIS RD",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163163341",
            "telephone_number": "814-382-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE PHYSICAL THERAPY AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-16",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-573-1549"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverly A Kennedy, RPH
• Brett Alan Keyser, D.C.
• Carolyn Knox
• Casey Lynn Kusich, RD, LDN
• Lakeside Chiropractic PC
• Izabella Leguard, MPAS, PA-C
• Mark J Leonard, P.T., D.P.T.
• Kimberly Nicole Litwin, PHARMD
• Candyce A. Lucian, D.O.
• Kaelyn R Mitchell, CRNP

• Physical Therapist in Conneaut Lake, PA
• Providers in Conneaut Lake, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2019; 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.