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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