Provider Demographics
NPI:1790276178
Name:IVYREHAB SEPT, LLC
Entity Type:Organization
Organization Name:IVYREHAB SEPT, LLC
Other - Org Name:SPECTRUM PHYSICAL THERAPY & SOUTHEASTERN THERAPY FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-777-8700
Mailing Address - Street 1:4668 PEMBROKE BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6423
Mailing Address - Country:US
Mailing Address - Phone:757-932-4261
Mailing Address - Fax:757-579-8690
Practice Address - Street 1:3253 TAYLOR RD STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2452
Practice Address - Country:US
Practice Address - Phone:757-881-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty