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
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1326539719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVYREHAB SEPT, LLC

Provider Business Mailing Address
First Line	:	4668 PEMBROKE BLVD STE 115
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6423
Country	:	US
Telephone Number	:	757-932-4261
Fax Number	:	757-579-8690

Provider Business Practice Location Address
First Line	:	12610 PATRICK HENRY DR STE H
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23602-9538
Country	:	US
Telephone Number	:	757-874-1470
Fax Number	:	757-874-1472

Authorized Official
Title or Position	:	EVP & CFO
Name	:	KENNETH MILES
Credential	:
Telephone Number	:	914-777-8700

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	09/14/2018

Similar Medicare Providers

1154126738 — GABRIELLE MARIE COLON
Practice Location Address:

12610 PATRICK HENRY DR STE H
NEWPORT NEWS, VA
23602-9538

Practice Phone: 757-874-1470
Practice Fax:

1073918165 — CLIFFORD T. GOODWIN, DDS
Practice Location Address:

12610 PATRICK HENRY DR , SUITE G
NEWPORT NEWS, VA
23602-9538

Practice Phone: 757-930-3744
Practice Fax: 757-930-2726

1750896999 — ALEXANDRA PAIGE KELLAS BCBA
Practice Location Address:

12610 PATRICK HENRY DR STE M
NEWPORT NEWS, VA
23602-9538

Practice Phone: 757-304-0224
Practice Fax:

1518472448 — ELIZABETH HARRIS M.A., BCBA, LBA
Practice Location Address:

12610 PATRICK HENRY DR STE M
NEWPORT NEWS, VA
23602-9538

Practice Phone: 757-817-0089
Practice Fax:

1891360921 — KAYLA JORDAN DUPREE PT, DPT
Practice Location Address:

12610 PATRICK HENRY DR STE H
NEWPORT NEWS, VA
23602-9538

Practice Phone: 757-847-1470
Practice Fax: 757-874-1472

1841927761 — CHRISTIAN ROWLAND PT, DPT
Practice Location Address:

12610 PATRICK HENRY DR STE H
NEWPORT NEWS, VA
23602-9538

Practice Phone: 757-874-1470
Practice Fax:

Directions to “IVYREHAB SEPT, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.