Provider Demographics
NPI:1063405645
Name:MCBAIN, DAVID G (LAT, ATC, CAA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:MCBAIN
Suffix:
Gender:M
Credentials:LAT, ATC, CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W ALLEGHENY RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:PA
Mailing Address - Zip Code:15126-9770
Mailing Address - Country:US
Mailing Address - Phone:724-695-5246
Mailing Address - Fax:724-695-1546
Practice Address - Street 1:205 W ALLEGHENY RD
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:PA
Practice Address - Zip Code:15126-9770
Practice Address - Country:US
Practice Address - Phone:724-695-5246
Practice Address - Fax:724-695-1546
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART-000627-A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer