Organization
IVYREHAB SEPT, LLC
Active
Organization
IVYREHAB SEPT, LLC
Active
Other names
Southeastern Therapy for Kids, SOUTHEASTERN PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH MILES (EVP/CFO)
(914) 777-8700
Entity
Organization
Contact information
Practice address
41 OLD OYSTER POINT RD STE E, NEWPORT NEWS, VA 23602-7177
(757) 223-1466
(757) 223-1467
Mailing address
4668 PEMBROKE BLVD STE 115, VIRGINIA BEACH, VA 23455-6423
(757) 648-8562
(757) 648-8564
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96660
—
VA
Enumeration date
04/24/2018
Last updated
09/14/2018
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