Provider Demographics
NPI:1992008379
Name:GRAND, LYNDSAY ALYSSA
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:ALYSSA
Last Name:GRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNDSAY
Other - Middle Name:ALYSSA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6231 LAGOON DR NE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6601
Mailing Address - Country:US
Mailing Address - Phone:218-444-4077
Mailing Address - Fax:
Practice Address - Street 1:614 MICHIGAN AVE W
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MN
Practice Address - Zip Code:56484-2276
Practice Address - Country:US
Practice Address - Phone:218-547-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist