Provider Demographics
NPI:1447734686
Name:COBERLEY, RENAE
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:
Last Name:COBERLEY
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 1:13155 HIGHWAY DD
Mailing Address - Street 2:
Mailing Address - City:PURDIN
Mailing Address - State:MO
Mailing Address - Zip Code:64674-8022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1337 W GRAND ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:MO
Practice Address - Zip Code:64640-8320
Practice Address - Country:US
Practice Address - Phone:660-663-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant