Active NPI
Cody B Doerflein
- Physical Therapist
- Carbondale, IL
National Provider Identifier
1114410206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070024815
- Practice address
- 214 W Freeman St
Carbondale, IL 62901-2809 - Phone
- (812) 491-1307
- Fax
- (618) 549-0226
- NPI assigned
- Jun 13, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070024815 | IL | Primary |
Addresses
Primary practice location
214 W Freeman St
Carbondale, IL 62901-2809
Mailing address
PO Box 3276
Evansville, IN 47731-3276
Phone (812) 473-0181
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070024815 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604880000000",
"number": "1114410206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3276",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477313276",
"telephone_number": "812-473-0181",
"fax_number": "812-473-5822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 W FREEMAN ST",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629012809",
"telephone_number": "812-491-1307",
"fax_number": "618-549-0226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOERFLEIN",
"first_name": "CODY",
"middle_name": "B",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-13",
"last_updated": "2020-11-09",
"certification_date": "2020-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070024815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.