MEDICARE: IVYREHAB SEPT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1235356155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVYREHAB SEPT, LLC

Provider Business Mailing Address
First Line	:	5301 PROVIDENCE RD
Second Line	:	SUITE 80
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4128
Country	:	US
Telephone Number	:	757-467-1900
Fax Number	:	757-467-7900

Provider Business Practice Location Address
First Line	:	1157 FIRST COLONIAL RD
Second Line	:	SUTE 201
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2432
Country	:	US
Telephone Number	:	757-481-0052
Fax Number	:	757-481-1099

Authorized Official
Title or Position	:	EVP & CFO
Name	:	MR. KENNETH MILES
Credential	:
Telephone Number	:	631-580-5200

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	11/20/2017

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Directions to “IVYREHAB SEPT, LLC ” Practice Location

Language	Start Address	Practice Location

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