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Ivyrehab Sept, LLC

Organization Active NPI Physical Medicine & Rehabilitation Physician · Newport News, VA

NPI 1326539719 · NPPES record last updated Sep 14, 2018

Key facts

NPI
1326539719
Entity type
Organization (NPI type 2)
Primary specialty
Physical Medicine & Rehabilitation Physician 208100000X
Legal business name
IVYREHAB SEPT, LLC
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
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 18

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

National Provider Directory

Tax ID family
Southeastern Physical T (19 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208100000X Yes

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

  • Southeastern Physical Therapy Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 14, 2018.

{
    "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

All providers in Newport News, VA · Physical Medicine & Rehabilitation Physician in Virginia

Sources for this page

Verify at the official NPI Registry.