Individual provider · NPI-1

Cody Elmendorf, ATC

Specialist/Technologist, Athletic Trainer · Saint Peters, MO

NPI number1306372461
StatusActive
Last updated in NPPESMay 11, 2017

Details

NPI
1306372461
Entity type
Individual (NPI-1)
Name
Cody Elmendorf
Credential
ATC
Sex
Male
Sole proprietor
Yes
Enumeration date
May 11, 2017
Last updated
May 11, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer––Yes

Other names

  • Thomas Cody Elmendorf (Other Name)

Practice location

1053 Windsor Crest Ct
Saint Peters, MO 63376-3850

Phone 636-627-9099

Mailing address

1053 Windsor Crest Ct
Saint Peters, MO 63376-3850

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