MEDICARE: IVY JEAN VILIRAN

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	309922	CA
2	225100000X	Physical Therapist	CP025331T	AZ
3	225100000X	Physical Therapist	CP036767T	VA
4	225100000X	Physical Therapist	P22174	NC

General Provider Information

NPI Number	:	1518641042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY JEAN VILIRAN

Provider Business Mailing Address
First Line	:	PO BOX 412307
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-2307
Country	:	US
Telephone Number	:	914-294-4050
Fax Number	:

Provider Business Practice Location Address
First Line	:	6065 MERIDIAN AVE STE 70
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2772
Country	:	US
Telephone Number	:	408-927-0871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	05/05/2026

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Directions to “ IVY JEAN VILIRAN ” Practice Location

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