Organization
ELEVATE THERAPY & PERFORMANCE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CODY B DOERFLEIN DPT (OWNER)
(618) 549-0225
Entity
Organization
Contact information
Practice address
214 W FREEMAN ST, CARBONDALE, IL 62901-2809
(812) 491-1307
(618) 549-0226
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070024815
STATE LICENSE
IL
Enumeration date
01/08/2020
Last updated
11/09/2020
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