OrganizationActive
Lakeside Physical Therapy, Rehab & Sports Medicine
NPI 1154780633 · Athletic Trainer · Lake Havasu City, AZ
Provider details
- NPI number
- 1154780633
- Entity type
- Organization
- Primary specialty
- Athletic TrainerRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Organization subpart
- No
- Authorized official
- Kristina Horton, Office Manager(928) 855-4248
- License
- 1448 (AZ)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Profile Score
Established profile(72/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
25 Riviera Blvd
Lake Havasu City, AZ 86403-5694
Phone: (928) 505-5555
Street-level locationGet directions
Mailing address
1791 Mesquite Ave
Lake Havasu City, AZ 86403-5648
Other names (DBA / former)
- Other name
- Lakeside Orthopedic Institute
Registry dates
- Enumerated
- 2016-02-12
- Last updated
- 2016-02-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.