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NPI Code Detail

MEDICARE: KORA NUTRITION THERAPY, LLC

MEDICARE: KORA NUTRITION THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDT84078TX
2133V00000XRegistered DietitianND7562FL

General Provider Information

NPI Number : 1386016285
Entity Type Code : Organization
Provider Name (Legal Business Name) : KORA NUTRITION THERAPY, LLC
Provider Business Mailing Address
First Line : PO BOX 48993
Second Line :
City : TAMPA
State : FL
Zip : 33646-0151
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15310 AMBERLY DR STE 250
Second Line :
City : TAMPA
State : FL
Zip : 33647-1642
Country : US
Telephone Number : 813-995-7497
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KELSEY COBLER
Credential : RDN, LD
Telephone Number : 979-236-2301
Provider Enumeration Date : 10/30/2015
Last Update Date : 03/17/2018

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Directions to “KORA NUTRITION THERAPY, LLC ” Practice Location

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