NPIMap

Organization Active NPI

Ivyrehab Sept, LLC

  • Physical Medicine & Rehabilitation Physician
  • Chesapeake, VA
National Provider Identifier
1790276178
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
Practice address
3253 Taylor Rd Ste 200
Chesapeake, VA 23321-2452
Phone
(757) 881-1138
NPI assigned
May 22, 2018
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

3253 Taylor Rd Ste 200
Chesapeake, VA 23321-2452

Mailing address

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

Other names 1

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

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Physical T19 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": "1790276178",
    "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": "3253 TAYLOR RD STE 200",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233212452",
            "telephone_number": "757-881-1138"
        }
    ],
    "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": "SPECTRUM PHYSICAL THERAPY & SOUTHEASTERN THERAPY FOR KIDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chesapeake, 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.