Provider Demographics
NPI:1134643042
Name:COHEN, CHANEL (PT,DPT, ATC)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:PT,DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9042 GRATEFUL THOMAS TRL APT 208
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1672
Mailing Address - Country:US
Mailing Address - Phone:929-400-5213
Mailing Address - Fax:
Practice Address - Street 1:9042 GRATEFUL THOMAS TRL APT 208
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1672
Practice Address - Country:US
Practice Address - Phone:929-400-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042237-1225100000X
FLPT39249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003262794OtherHUSKY HEALTH