Healthcare Provider Details

I. General information

NPI: 1376917187
Provider Name (Legal Business Name): IVYREHAB PHYSICAL THERAPY, OCCUPATIONAL THERAPY & SPEECH LANGUAGE PATH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E WASHINGTON ST
CLINTON IL
61727-1715
US

IV. Provider business mailing address

PO BOX 416501
BOSTON MA
02241-7594
US

V. Phone/Fax

Practice location:
  • Phone: 217-570-0225
  • Fax: 217-570-0227
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY GRIFFITHS
Title or Position: SR. DIRECTOR OF PROVIDER RELATIONS
Credential:
Phone: 914-294-4050