Provider Demographics
NPI:1548891476
Name:BAIN, VERONICA FRANCES (LAT, ATC)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:FRANCES
Last Name:BAIN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2683 N 1050 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2549
Mailing Address - Country:US
Mailing Address - Phone:775-530-3950
Mailing Address - Fax:
Practice Address - Street 1:430 W WEBER HIGH DR
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84414-1455
Practice Address - Country:US
Practice Address - Phone:801-476-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8720359-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer