Elite Rehab Holtville LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

ELITE REHAB HOLTVILLE LLC

Practice address

213 Lightwood Rd Ste 2
Deatsville, AL 36022

Phone

(334) 543-4269

Fax

(334) 543-4272

NPI assigned

Apr 14, 2022

Last updated

Apr 24, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pamela P Van Etten

Title

Administrator

Phone

(334) 799-5853

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

Practitioners 7

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.

• Cody Brian Dingman, DPT

  • Physical Therapist
  • Deatsville, AL
  • NPI 1760211130
  Medicare reassignment Care Compare group NPD
• Jonathon Worth Locke

  • Physical Therapist
  • Montgomery, AL
  • NPI 1962048454
  Medicare reassignment Care Compare group NPD
• Clint D Mann, DPT

  • Physical Therapist
  • Montgomery, AL
  • NPI 1124348875
  Medicare reassignment Care Compare group NPD
• Albert James Mayhan IV, PT

  • Physical Therapist
  • Montgomery, AL
  • NPI 1619421435
  Medicare reassignment Care Compare group NPD
• Dakota Andrew Vessicchio, DPT

  • Physical Therapist
  • Montgomery, AL
  • NPI 1700609724
  Medicare reassignment Care Compare group NPD
• Jared Merrill Blair, DPT

  • Physical Therapist
  • Tallassee, AL
  • NPI 1689969701
  Medicare reassignment NPD
• Tyson Carter Crisman, MPT

  • Physical Therapist
  • Prattville, AL
  • NPI 1306954276
  Medicare reassignment NPD

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1649913120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 LIGHTWOOD RD STE 2",
            "city": "DEATSVILLE",
            "state": "AL",
            "postal_code": "36022",
            "telephone_number": "334-543-4269",
            "fax_number": "334-543-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 LIGHTWOOD RD STE 2",
            "city": "DEATSVILLE",
            "state": "AL",
            "postal_code": "36022",
            "telephone_number": "334-543-4269",
            "fax_number": "334-543-4272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE REHAB HOLTVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-14",
        "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": "P",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-799-5853"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Elizabeth Brady, NURSE PRACTITIONER
• Robert Steven Browning, OTR/L; RN
• Mary Kelley Cousins, NP
• Deatsville Care Foundation, Inc. (Resurrection Life Center)
• Cody Brian Dingman, DPT
• Express Mro (Pine Level Family Care)
• William Donald Gill II, PT
• Robert L Golden Jr.
• Justin Edward Henry
• Hoff

• Physical Therapy Clinic/Center in Deatsville, AL
• Providers in Deatsville, AL by specialty
• Physical Therapy Clinic/Center in Alabama

• 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.