Provider Demographics
NPI:1306372461
Name:ELMENDORF, CODY (ATC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:ELMENDORF
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:CODY
Other - Last Name:ELMENDORF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:1053 WINDSOR CREST CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1053 WINDSOR CREST CT
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3850
Practice Address - Country:US
Practice Address - Phone:636-627-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer