Provider Demographics
NPI:1033782701
Name:ELITE REHAB WEDOWEE LLC
Entity Type:Organization
Organization Name:ELITE REHAB WEDOWEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:VAN ETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-799-5853
Mailing Address - Street 1:1258 MAIN ST S STE 3&4
Mailing Address - Street 2:
Mailing Address - City:WEDOWEE
Mailing Address - State:AL
Mailing Address - Zip Code:36278-7180
Mailing Address - Country:US
Mailing Address - Phone:256-357-1077
Mailing Address - Fax:256-357-1078
Practice Address - Street 1:1258 MAIN ST S STE 3&4
Practice Address - Street 2:
Practice Address - City:WEDOWEE
Practice Address - State:AL
Practice Address - Zip Code:36278-7180
Practice Address - Country:US
Practice Address - Phone:256-357-1077
Practice Address - Fax:256-357-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy