Provider Demographics
NPI:1952001976
Name:TALLASSEE REHAB
Entity type:Organization
Organization Name:TALLASSEE REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
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:334-541-2199
Mailing Address - Street 1:7697 UPPER RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-3453
Mailing Address - Country:US
Mailing Address - Phone:334-541-2199
Mailing Address - Fax:334-541-5013
Practice Address - Street 1:36 KOWALIGA RD
Practice Address - Street 2:STE 11
Practice Address - City:ECLECTIC
Practice Address - State:AL
Practice Address - Zip Code:36024-5618
Practice Address - Country:US
Practice Address - Phone:343-541-2199
Practice Address - Fax:334-541-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
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