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DYNAMIC MEDICAL AND REHAB PLLC NPI 1417256710


NPI Information

NPI: 1417256710
Provider Name: DYNAMIC MEDICAL AND REHAB PLLC
Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Organization

Specialization: Neurology

Address:
3747 DIANN MARIE RD
LOUISVILLE, KY
ZIP 40241
Phone: (502) 426-9200
Get Directions

DYNAMIC MEDICAL AND REHAB PLLC is a neurology psychiatry neurology in Louisville, KY. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. DYNAMIC MEDICAL AND REHAB PLLC NPI is 1417256710. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3747 DIANN MARIE RD
LOUISVILLE, KY
ZIP 40241
Phone: (502) 426-9200
Fax: (502) 426-9259

The provider's authorized official is Blaine Lisner .
The authorized official title is Md/owner and has the following contact phone number (502) 426-9200.

The enumeration date for this NPI number is 3/25/2011 and was last updated on 8/5/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1111N00000XChiropractorKENTUCKYNo
2174400000XSpecialistNo
3332B00000XDurable Medical Equipment & Medical SuppliesNo
4363A00000XPhysician AssistantKENTUCKYNo
5363L00000XNurse PractitionerNo
62084N0400XPsychiatry & NeurologyNeurologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
17100210390MEDICAIDKENTUCKY
27100210310MEDICAIDKENTUCKY
37100234180MEDICAIDKENTUCKY
4000000710768OTHERKENTUCKYANTHEM
57100206020MEDICAIDKENTUCKY
67100205820MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.