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General NPI Number Information
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NPI Number | 1750764494
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Entity Type | Organization
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Legal Business Name | IVYREHAB PHYSICAL THERAPY, OCCUPATIONAL THERAPY & SPEECH LANGUAGE PATHOLOGY, PLLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5 BROADWAY PLZ
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City | PERU
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State | IN
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Zip | 46970-1052
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Country | US
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Telephone | 631-580-5200
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Fax | 631-580-5222
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Provider Business Mailing Address
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Address Line | PO BOX 416501
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City | BOSTON
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State | MA
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Zip | 02241-7594
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Country | US
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Telephone | 914-294-4050
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Fax |
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Authorized Official
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Title or Position | SR. DIRECTOR OF PROVIDER RELATIONS
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Name | ASHLEY GRIFFITHS
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Credential |
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Telephone | 914-294-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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