Elite Rehab Heflin LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ELITE REHAB HEFLIN LLC

Practice address

141 Willoughby St
Heflin, AL 36264-1425

Phone

(256) 635-7212

Fax

(256) 573-1089

NPI assigned

Jan 30, 2023

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 4

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.

• Jared Merrill Blair, DPT

  • Physical Therapist
  • Tallassee, AL
  • NPI 1689969701
  Medicare reassignment NPD
• Clint D Mann, DPT

  • Physical Therapist
  • Montgomery, AL
  • NPI 1124348875
  Medicare reassignment NPD
• Ginger C Roberts, PT

  • Physical Therapist
  • Oxford, AL
  • NPI 1457316903
  Medicare reassignment NPD
• Dalton Screws

  • Physical Therapist
  • Roanoke, AL
  • NPI 1538793401
  Medicare reassignment NPD

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

{
    "created_epoch": "1675036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1811603129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 WILLOUGHBY ST",
            "city": "HEFLIN",
            "state": "AL",
            "postal_code": "362641425",
            "telephone_number": "256-635-7212",
            "fax_number": "256-573-1089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 WILLOUGHBY ST",
            "city": "HEFLIN",
            "state": "AL",
            "postal_code": "362641425",
            "telephone_number": "256-635-7212",
            "fax_number": "256-573-1089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE REHAB HEFLIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-30",
        "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": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Essential Living LLC
• Family Pharmacy, Inc (Wright Drug Company)
• Holley Fenn, LPC
• Fuller Counseling and Educational Resources LLC (Fuller Life Counseling)
• Tiffany Rose Fuller, ALC

• Physical Therapist in Heflin, AL
• Providers in Heflin, AL by specialty
• Physical Therapist 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.