Organization
IVYREHAB NORTHERN PT, LLC
Active
Other names
Northern Physical Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL RUCKER (CEO)
(914) 777-8700
Entity
Organization
Contact information
Practice address
31 IDA RED AVE, SPARTA, MI 49345-1277
(616) 887-8152
(616) 887-3809
Mailing address
1311 MAMARONECK AVE STE 140, WHITE PLAINS, NY 10605-5224
(914) 294-4050
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/17/2005
Last updated
08/12/2022
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