Provider Demographics
NPI:1417755414
Name:BAIN, JOHN RODERICK (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RODERICK
Last Name:BAIN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:ROD
Other - Middle Name:
Other - Last Name:BAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:7602 N 177TH AVE
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-9384
Mailing Address - Country:US
Mailing Address - Phone:623-208-3731
Mailing Address - Fax:
Practice Address - Street 1:14581 W PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3600
Practice Address - Country:US
Practice Address - Phone:623-253-1228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-008267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist