Organization
LAKESIDE ORTHOPEDIC INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WESLEY JAMES JOHNSON M.D. (PRESIDENT)
92885455555
Entity
Organization
Contact information
Practice address
1979 MCCULLOCH BLVD N, SUITE 101, LAKE HAVASU CITY, AZ 86403-0953
(928) 855-4842
(928) 855-7452
Mailing address
25 RIVIERA BLVD, LAKE HAVASU CITY, AZ 86403-5694
(928) 854-5555
(928) 854-5573
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2641
AZ
225100000X
Physical Therapist
6762
AZ
225100000X
Physical Therapist
8192
AZ
Other
Enumeration date
05/05/2009
Last updated
05/05/2009
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