Provider Demographics
NPI:1508189069
Name:BAIN, FRANK CHARLES JR
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:CHARLES
Last Name:BAIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:
Other - Last Name:BAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:7310 W MCNAB RD STE 107
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5327
Mailing Address - Country:US
Mailing Address - Phone:954-657-8342
Mailing Address - Fax:954-657-8516
Practice Address - Street 1:7310 W MCNAB RD STE 107
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5327
Practice Address - Country:US
Practice Address - Phone:954-657-8342
Practice Address - Fax:954-657-8516
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist