Provider Demographics
NPI:1871133876
Name:ELEVATE THERAPY & PERFORMANCE PC
Entity type:Organization
Organization Name:ELEVATE THERAPY & PERFORMANCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOERFLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:618-549-0225
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:214 W FREEMAN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2809
Practice Address - Country:US
Practice Address - Phone:812-491-1307
Practice Address - Fax:618-549-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070024815OtherSTATE LICENSE