Provider Demographics
NPI:1487836680
Name:FAIN, HENRIA M (MD, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:HENRIA
Middle Name:M
Last Name:FAIN
Suffix:
Gender:F
Credentials:MD, DPT, ATC
Other - Prefix:MRS
Other - First Name:HENRIA
Other - Middle Name:M
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 75496
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33675-0496
Mailing Address - Country:US
Mailing Address - Phone:813-743-4383
Mailing Address - Fax:888-713-4253
Practice Address - Street 1:800 W. MARTIN LUTHER KING JR. BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-743-4383
Practice Address - Fax:888-713-4253
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10700225100000X
FL19365225100000X
FLME133303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist