Provider Demographics
NPI:1447287297
Name:BRINK, LISA K (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:BRINK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 GOLF COURSE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-9603
Mailing Address - Country:US
Mailing Address - Phone:218-326-3300
Mailing Address - Fax:218-326-5941
Practice Address - Street 1:1542 GOLF COURSE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-9603
Practice Address - Country:US
Practice Address - Phone:218-326-3300
Practice Address - Fax:218-326-5941
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist