NPIMap

Organization Active NPI

Ivyrehab Sept, LLC

Doing business as Spectrum Physical Therpay & Southeastern Therapy for Kids

  • Physical Medicine & Rehabilitation Physician
  • Chester, VA
National Provider Identifier
1174014559
Registry record updated May 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
IVYREHAB SEPT, LLC
Doing business as
Spectrum Physical Therpay & Southeastern Therapy for Kids
Practice address
3501 Festival Park PLZ
Chester, VA 23831-4449
Phone
(804) 930-8280
Fax
(804) 930-8101
NPI assigned
May 22, 2018
Last updated
May 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenneth Miles
Title
Evp & Cfo
Phone
(914) 777-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X Primary

Addresses

Primary practice location

3501 Festival Park PLZ
Chester, VA 23831-4449

Mailing address

4668 Pembroke Blvd Ste 115
Virginia Beach, VA 23455-6423
Phone (757) 932-4261

Other names 1

  • SPECTRUM PHYSICAL THERPAY & SOUTHEASTERN THERAPY FOR KIDS Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Physical Therapy19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526947200000",
    "number": "1174014559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4668 PEMBROKE BLVD STE 115",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234556423",
            "telephone_number": "757-932-4261",
            "fax_number": "757-579-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 FESTIVAL PARK PLZ",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238314449",
            "telephone_number": "804-930-8280",
            "fax_number": "804-930-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVYREHAB SEPT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-22",
        "last_updated": "2018-05-22",
        "status": "A",
        "authorized_official_last_name": "MILES",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "914-777-8700"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPECTRUM PHYSICAL THERPAY & SOUTHEASTERN THERAPY FOR KIDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.