Provider Demographics
NPI:1740499441
Name:BAIN, JUSTIN (LAT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:BAIN
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 S STAPLES ST
Mailing Address - Street 2:#3010
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3732
Mailing Address - Country:US
Mailing Address - Phone:361-533-2529
Mailing Address - Fax:
Practice Address - Street 1:1002 TEXAN TRL
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2530
Practice Address - Country:US
Practice Address - Phone:361-806-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT36182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer