Healthcare Provider Details

I. General information

NPI: 1942996848
Provider Name (Legal Business Name): COBY THRAILKILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E COOPER ST
GREEN RIDGE MO
65332-1025
US

IV. Provider business mailing address

104 E COOPER ST
GREEN RIDGE MO
65332-1025
US

V. Phone/Fax

Practice location:
  • Phone: 660-988-4902
  • Fax:
Mailing address:
  • Phone: 660-988-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP042840A
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPT20240095
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP022192A
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2019011918
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP044036A
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: