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
5301 PROVIDENCE RD, SUITE 80, VIRGINIA BEACH, VA 23464-4128
(757) 467-4604
(757) 467-2716
Mailing address
PO BOX 412307, BOSTON, MA 02241-2307
(914) 294-4050
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
05/18/2006
Last updated
09/09/2024
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