Provider Demographics
NPI:1376969501
Name:KOHARI, HENNA (DO)
Entity Type:Individual
Prefix:
First Name:HENNA
Middle Name:
Last Name:KOHARI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 E FLETCHER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4907
Mailing Address - Country:US
Mailing Address - Phone:813-336-5237
Mailing Address - Fax:813-336-2112
Practice Address - Street 1:4450 E FLETCHER AVE STE C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4907
Practice Address - Country:US
Practice Address - Phone:813-336-5237
Practice Address - Fax:813-336-2112
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16142208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation