NPIMap

Organization Active NPI

Elite Rehab Inc

Doing business as Elite Rehab @ Capitol City

  • Physical Therapy Clinic/Center
  • Montgomery, AL
National Provider Identifier
1588020606
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ELITE REHAB INC
Doing business as
Elite Rehab @ Capitol City
Practice address
1636 Mulberry St
Montgomery, AL 36106-1522
Phone
(334) 265-3199
Fax
(334) 265-3189
NPI assigned
Jan 5, 2016
Last updated
Apr 24, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ELITE REHAB INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Pamela Palmer Van Etten
Title
Administrator
Phone
(334) 799-5853

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

1636 Mulberry St
Montgomery, AL 36106-1522

Mailing address

935 Highway 431 Ste 1
Roanoke, AL 36274-7332
Phone (334) 863-2068

Other names 1

  • Elite Rehab @ Capitol City Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150319001885 AL Part B Supplier - Clinic/Group Practice 9436476066 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pike Road, AL; Prattville, AL; Roanoke, AL; Montgomery, AL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Elite Rehab Inc2 organizations share this tax ID, including this one
Part of
Elite Rehab Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

405 E Barbour St
Ste 5
Eufaula, AL 36027
Phone (334) 687-9831

1636 Mulberry St
Montgomery, AL 36106
Phone (334) 265-3199

102 Medical Center Dr
Ste G
Prattville, AL 36066
Phone (334) 239-0708

935 Highway 431
Ste 1
Roanoke, AL 36274
Phone (334) 799-5853

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1588020606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 HIGHWAY 431 STE 1",
            "city": "ROANOKE",
            "state": "AL",
            "postal_code": "362747332",
            "telephone_number": "334-863-2068",
            "fax_number": "334-863-2069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 MULBERRY ST",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361061522",
            "telephone_number": "334-265-3199",
            "fax_number": "334-265-3189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE REHAB INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELITE REHAB INC",
        "enumeration_date": "2016-01-05",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A",
        "authorized_official_last_name": "VAN ETTEN",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "PALMER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-799-5853"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Rehab @ Capitol City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.