Organization
DYNAMIC MEDICAL AND REHAB PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAINE LISNER MD (MD/OWNER)
(502) 426-9200
Entity
Organization
Contact information
Practice address
3747 DIANN MARIE RD, LOUISVILLE, KY 40241
(502) 426-9200
(502) 426-9259
Mailing address
3747 DIANN MARIE RD, LOUISVILLE, KY 40241
(502) 426-9200
(502) 426-9259
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
KY
174400000X
Specialist
—
—
2084N0400X
Neurology Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
KY
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000710768
ANTHEM
KY
05
—
7100205820
—
KY
05
—
7100206020
—
KY
05
—
7100210310
—
KY
05
—
7100210390
—
KY
05
—
7100234180
—
KY
Enumeration date
03/25/2011
Last updated
08/05/2021
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