Provider Demographics
NPI:1588020606
Name:ELITE REHAB INC
Entity Type:Organization
Organization Name:ELITE REHAB INC
Other - Org Name:ELITE REHAB @ CAPITOL CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:PALMER
Authorized Official - Last Name:VAN ETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-799-5853
Mailing Address - Street 1:935 HIGHWAY 431 STE 1
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-7332
Mailing Address - Country:US
Mailing Address - Phone:334-863-2068
Mailing Address - Fax:334-863-2069
Practice Address - Street 1:1636 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1522
Practice Address - Country:US
Practice Address - Phone:334-265-3199
Practice Address - Fax:334-265-3189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE REHAB INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-05
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy