Dynamic Medical and Rehab PLLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

DYNAMIC MEDICAL AND REHAB PLLC

Practice address

3747 Diann Marie Rd
Louisville, KY 40241

Phone

(502) 426-9200

Fax

(502) 426-9259

NPI assigned

Mar 25, 2011

Last updated

Aug 5, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Blaine Lisner, MDNPI 1629085949

Title

MD/Owner

Phone

(502) 426-9200

Specialties & licenses 6

Addresses

Other identifiers 6

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Blaine M Lisner, M.D.

  • Neurology Physician
  • Louisville, KY
  • NPI 1629085949
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1417256710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3747 DIANN MARIE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40241",
            "telephone_number": "502-426-9200",
            "fax_number": "502-426-9259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3747 DIANN MARIE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40241",
            "telephone_number": "502-426-9200",
            "fax_number": "502-426-9259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC MEDICAL AND REHAB PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-25",
        "last_updated": "2021-08-05",
        "certification_date": "2021-07-19",
        "status": "A",
        "authorized_official_last_name": "LISNER",
        "authorized_official_first_name": "BLAINE",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "502-426-9200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100206020",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100210310",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100210390",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000710768",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100205820",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100234180",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Dykes, MD
• Christina Jan Dykiel
• Dylan Murphy DO PSC
• Dym Bhso
• Dynamic Chiropractic PLLC
• Dynamic Medical and Rehab, LLC
• Dynamic Wound Care LLC
• Vertina Dyson, RN
• Caroline Carnes Dzenitis
• Inna M Dziekan, PHARM.D.

• Neurology Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Neurology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.