# IVYREHAB SEPT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southeastern Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326539719
- **Authorized official:** KENNETH MILES (EVP & CFO)
- **Authorized official phone:** (914) 777-8700

## Contact information

- **Practice address:** 12610 PATRICK HENRY DR STE H, NEWPORT NEWS, VA 23602-9538
- **Practice address phone:** (757) 874-1470
- **Practice address fax:** (757) 874-1472
- **Mailing address:** 4668 PEMBROKE BLVD STE 115, VIRGINIA BEACH, VA 23455-6423
- **Mailing address phone:** (757) 932-4261
- **Mailing address fax:** (757) 579-8690

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2018
- **Last updated:** 09/14/2018