MEDICARE: NANCY BAIN MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	759	AK

General Provider Information

NPI Number	:	1326457821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY BAIN MPT

Provider Business Mailing Address
First Line	:	8630 JUPITER DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-3702
Country	:	US
Telephone Number	:	907-336-8837
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 G ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99501-5049
Country	:	US
Telephone Number	:	907-344-6261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	08/08/2014

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