Provider Demographics
NPI:1407066509
Name:MINN, LISA BOLHEIMER (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BOLHEIMER
Last Name:MINN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BOLHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2750 BEECHWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2706
Mailing Address - Country:US
Mailing Address - Phone:415-561-6655
Mailing Address - Fax:415-561-6650
Practice Address - Street 1:826 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2972
Practice Address - Country:US
Practice Address - Phone:412-414-1988
Practice Address - Fax:412-924-4079
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PT301200Medicare PIN