Organization
IVYREHAB SEPT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH MILES (EVP & CFO)
(631) 580-5200
Entity
Organization
Contact information
Practice address
70 JEFFERSON COURT, SUITE 102, ZION CROSSROADS, VA 22942
(540) 832-3061
(540) 832-3062
Mailing address
5301 PROVIDENCE RD, SUITE 80, VIRGINIA BEACH, VA 23464-4128
(757) 932-4261
(757) 467-7900
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
05/22/2015
Last updated
11/20/2017
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