# IVYREHAB NORTH CAROLINA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528683935
- **Authorized official:** MICHAEL RUCKER (CEO)
- **Authorized official phone:** (914) 777-8700

## Contact information

- **Practice address:** 9216 ARDEY KELL ROAD, STE 300, CHARLOTTE, NC 28277-4954
- **Practice address phone:** (980) 556-7330
- **Practice address fax:** (980) 939-8215
- **Mailing address:** 1377 MOTOR PKWY STE 307, ISLANDIA, NY 11749-5258
- **Mailing address phone:** (631) 580-5200
- **Mailing address fax:** (631) 824-9219

## Taxonomy

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

## Other

- **Enumeration date:** 06/11/2020
- **Last updated:** 06/11/2020