Healthcare Provider Details

I. General information

NPI: 1407066509
Provider Name (Legal Business Name): LISA BOLHEIMER MINN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA BOLHEIMER

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 HAZELWOOD AVE
PITTSBURGH PA
15217-2972
US

IV. Provider business mailing address

2750 BEECHWOOD BLVD
PITTSBURGH PA
15217-2706
US

V. Phone/Fax

Practice location:
  • Phone: 412-414-1988
  • Fax: 412-924-4079
Mailing address:
  • Phone: 415-561-6655
  • Fax: 415-561-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 30120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: