Active NPI
Lyndsay Alyssa Grand
- Physical Therapist
- Walker, MN
National Provider Identifier
1992008379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 8126
- Practice address
- 614 Michigan Ave W
Walker, MN 56484-2276 - Phone
- (218) 547-1099
- NPI assigned
- Dec 7, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 8126 | MN | Primary |
Addresses
Primary practice location
614 Michigan Ave W
Walker, MN 56484-2276
Mailing address
6231 Lagoon Dr NE
Bemidji, MN 56601-6601
Phone (218) 444-4077
Other names 1
- Lyndsay Alyssa Johnson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489708800000",
"number": "1992008379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6231 LAGOON DR NE",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566016601",
"telephone_number": "218-444-4077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "614 MICHIGAN AVE W",
"city": "WALKER",
"state": "MN",
"postal_code": "564842276",
"telephone_number": "218-547-1099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAND",
"first_name": "LYNDSAY",
"middle_name": "ALYSSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-12-07",
"last_updated": "2017-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "8126",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LYNDSAY",
"last_name": "JOHNSON",
"middle_name": "ALYSSA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Walker, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.