Organization
IVYREHAB SEPT, LLC
Active
Other names
Southeastern Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RUCKER (CEO)
(914) 294-4050
Entity
Organization
Contact information
Practice address
138 STONERIDGE DR N, SUITE 4, RUCKERSVILLE, VA 22968-3063
(434) 985-2288
(434) 985-6909
Mailing address
1311 MAMARONECK AVE STE 140, WHITE PLAINS, NY 10605-5224
(914) 294-4050
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
04/20/2007
Last updated
10/03/2024
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