Provider Demographics
NPI:1669059788
Name:PHENIX CITY ELITE REHAB SOLUTIONS LLC
Entity type:Organization
Organization Name:PHENIX CITY ELITE REHAB SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN ETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-799-5853
Mailing Address - Street 1:5409 SUMMERVILLE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7437
Mailing Address - Country:US
Mailing Address - Phone:334-947-1327
Mailing Address - Fax:334-408-2460
Practice Address - Street 1:5409 SUMMERVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7437
Practice Address - Country:US
Practice Address - Phone:334-947-1327
Practice Address - Fax:334-408-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty