NPIMap

Organization Active NPI

Tallassee Rehab

  • Physical Therapist
  • Tuskegee, AL
National Provider Identifier
1912055690
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
TALLASSEE REHAB
Practice address
301 Wright St
Tuskegee, AL 36083-1558
Phone
(334) 725-1261
Fax
(334) 725-1262
NPI assigned
Jan 8, 2007
Last updated
Nov 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Authorized official

Name
Ms. Pamela Van Etten
Title
Dir of Cred & Acc Payable
Phone
(334) 283-8032

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

301 Wright St
Tuskegee, AL 36083-1558

Mailing address

1000 Friendship Rd
Tallassee, AL 36078-1265
Phone (334) 283-8032

Other identifiers 1

IdentifierTypeStateIssuer
890007880MedicaidAL

Other names 1

  • Crain Rehab Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040728001714 AL Part B Supplier - Clinic/Group Practice 0840260626 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tallassee, AL; Tuskegee, 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
Crain Rehab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

209 W Martin Luther King Hwy
Ste A
Tuskegee, AL 36083
Phone (334) 725-1261

802 Crawford St
Tuskegee, AL 36083
Phone (334) 725-1261

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1912055690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 FRIENDSHIP RD",
            "city": "TALLASSEE",
            "state": "AL",
            "postal_code": "360781265",
            "telephone_number": "334-283-8032",
            "fax_number": "334-283-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 WRIGHT ST",
            "city": "TUSKEGEE",
            "state": "AL",
            "postal_code": "360831558",
            "telephone_number": "334-725-1261",
            "fax_number": "334-725-1262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLASSEE REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "VAN ETTEN",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "DIR OF CRED & ACC PAYABLE",
        "authorized_official_telephone_number": "334-283-8032",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890007880",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crain Rehab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tuskegee, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; 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.