MEDICARE: IVYREHAB SEPT, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	251S00000X	Community/Behavioral Health Agency
4	261QR0400X	Rehabilitation Clinic/Center
5	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1982657433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVYREHAB SEPT, LLC

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	:	5301 PROVIDENCE RD
Second Line	:	SUITE 80
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4128
Country	:	US
Telephone Number	:	757-467-4604
Fax Number	:	757-467-2716

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL RUCKER
Credential	:
Telephone Number	:	914-294-4050

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/09/2024

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Directions to “IVYREHAB SEPT, LLC ” Practice Location

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