Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8987 | TN |
N | 2251X0800X | Physical Therapist - Orthopedic | 13255 | NC |
NPI | 1073801973 |
---|---|
Provider Name | Andrea N Bain |
First Address | Ooltewah, TN 37363-6511 |
Second Address | Pulaski, TN 38478-2929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 07/03/2016 |