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General NPI Number Information
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NPI Number | 1417755414
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Entity Type | Individual
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Provider Name | JOHN RODERICK BAIN PT
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Gender | Male
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 14581 W PARKWOOD DR
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City | SURPRISE
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State | AZ
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Zip | 85374-3600
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Country | US
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Telephone | 623-253-1228
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Fax |
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Provider Business Mailing Address
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Address Line | 7602 N 177TH AVE
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City | WADDELL
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State | AZ
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Zip | 85355-9384
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Country | US
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Telephone | 623-208-3731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | LPT-008267
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License Number State | AZ
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