Provider Demographics
NPI:1730301193
Name:COHEN, CHARI
Entity Type:Individual
Prefix:MRS
First Name:CHARI
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PINE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3648
Mailing Address - Country:US
Mailing Address - Phone:561-361-0307
Mailing Address - Fax:561-393-6903
Practice Address - Street 1:130 PINE CIRCLE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3648
Practice Address - Country:US
Practice Address - Phone:561-361-0307
Practice Address - Fax:561-393-6903
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8748225100000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL881701400Medicaid