NPIMap

Organization Active NPI

Ivyrehab Sept, LLC

Doing business as Southeastern Physical Therapy

  • Physical Medicine & Rehabilitation Physician
  • Newport News, VA
National Provider Identifier
1326539719
Registry record updated Sep 14, 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
Southeastern Physical Therapy
Practice address
12610 Patrick Henry Dr Ste H
Newport News, VA 23602-9538
Phone
(757) 874-1470
Fax
(757) 874-1472
NPI assigned
May 22, 2018
Last updated
Sep 14, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 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 PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

12610 Patrick Henry Dr Ste H
Newport News, VA 23602-9538

Mailing address

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

Other names 1

  • Southeastern Physical Therapy 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": "1536883200000",
    "number": "1326539719",
    "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": "12610 PATRICK HENRY DR STE H",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236029538",
            "telephone_number": "757-874-1470",
            "fax_number": "757-874-1472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVYREHAB SEPT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-22",
        "last_updated": "2018-09-14",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeastern Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.