Provider Demographics
NPI:1942436530
Name:THRAILKILL, SARAH M (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:THRAILKILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S 4J RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5201
Mailing Address - Country:US
Mailing Address - Phone:307-682-2392
Mailing Address - Fax:
Practice Address - Street 1:1801 S 4J RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5201
Practice Address - Country:US
Practice Address - Phone:076-822-3923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1942436530Medicaid
WYLICENSE # PT1193OtherLICENSE # PT 1193
WYW22797Medicare PIN
WYDME 5767920001Medicare PIN