Organization
NORTHWEST ORTHOPEDIC & SPORTS PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACY LA' NETTE WYSOPAL (MANAGING MEMBER)
(623) 556-5013
Entity
Organization
Contact information
Practice address
13540 W CAMINO DEL SOL STE 6, SUN CITY WEST, AZ 85375-4435
(623) 556-5013
(480) 508-5894
Mailing address
13540 W CAMINO DEL SOL STE 6, SUN CITY WEST, AZ 85375-4435
(623) 556-5013
(480) 508-5894
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
—
AZ
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DF2066
RAILROAD MEDICARE
AZ
Enumeration date
09/20/2006
Last updated
12/12/2025
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