# ELEVATE THERAPY & PERFORMANCE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871133876
- **Authorized official:** CODY B DOERFLEIN DPT (OWNER)
- **Authorized official phone:** (618) 549-0225

## Contact information

- **Practice address:** 214 W FREEMAN ST, CARBONDALE, IL 62901-2809
- **Practice address phone:** (812) 491-1307
- **Practice address fax:** (618) 549-0226
- **Mailing address:** PO BOX 3276, EVANSVILLE, IN 47731-3276
- **Mailing address phone:** (812) 473-0181
- **Mailing address fax:** (812) 473-5822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/08/2020
- **Last updated:** 11/09/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 070024815 | STATE LICENSE | IL |