Healthcare Provider Details

I. General information

NPI: 1750312849
Provider Name (Legal Business Name): TALLASSEE REHAB PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FRIENDSHIP RD
TALLASSEE AL
36078-1265
US

IV. Provider business mailing address

1000 FRIENDSHIP RD
TALLASSEE AL
36078-1265
US

V. Phone/Fax

Practice location:
  • Phone: 334-283-8032
  • Fax: 334-283-1136
Mailing address:
  • Phone: 334-283-8032
  • Fax: 334-283-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAMELA VAN ETTEN
Title or Position: PT OWNER
Credential: PT
Phone: 334-799-5853