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NPI Code Detail

MEDICARE: IVYREHAB SEPT, LLC

MEDICARE: IVYREHAB SEPT, LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist

General Provider Information

NPI Number : 1235356163
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 : 757-932-4261
Fax Number : 757-467-7900
Provider Business Practice Location Address
First Line : 3509 GRANBY ST
Second Line : SUITE B
City : NORFOLK
State : VA
Zip : 23504-1312
Country : US
Telephone Number : 757-423-8885
Fax Number : 757-423-8886
Authorized Official
Title or Position : EVP & CFO
Name : 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

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