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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up