NPIMap

Organization Active NPI

Ivyrehab Sept, LLC

  • Physical Therapist
  • Virginia Beach, VA
National Provider Identifier
1982657433
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
IVYREHAB SEPT, LLC
Practice address
5301 Providence Rd
Suite 80
Virginia Beach, VA 23464-4128
Phone
(757) 467-4604
Fax
(757) 467-2716
NPI assigned
May 18, 2006
Last updated
Sep 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Authorized official

Name
Michael Rucker
Title
Ceo
Phone
(914) 294-4050

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU
Physical Therapist 225100000X NU Primary
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

5301 Providence Rd
Suite 80
Virginia Beach, VA 23464-4128

Mailing address

PO Box 412307
Boston, MA 02241-2307
Phone (914) 294-4050

Other names 1

  • SOUTHEASTERN PHYSICAL THERAPY Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20160826000390 VA DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 7911990908 Practice locations: Zion Crossroads, VA
O20240202000799 VA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7911990908 Receives reassigned benefits from 278 practitioners
Practice locations: Norfolk, VA; Orange, VA; Palmyra, VA; Richmond, VA; Roanoke, VA; Ruckersville, VA; Salem, VA; Scottsville, VA…
O20240212002520 DC Part B Supplier - Clinic/Group Practice 7911990908 Receives reassigned benefits from 15 practitioners
Practice locations: Alexandria, VA; Arlington, VA; Falls Church, VA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1068 N Fayette St
Alexandria, VA 22314

1460 Pantops Mountain Pl
Charlottesville, VA 22911
Phone (434) 817-4100

1622 Timberwood Blvd
Ste 211
Charlottesville, VA 22911
Phone (434) 202-2830

4290 Ivy Rd
Ste 120
Charlottesville, VA 22903
Phone (434) 327-5244

1301 Cedar Rd
Chesapeake, VA 23322
Phone (757) 512-7626

3253 Taylor Rd
Ste 200
Chesapeake, VA 23321
Phone (757) 686-5673

905 Battlefield Blvd N
Ste 105
Chesapeake, VA 23320
Phone (757) 410-3157

16260 Bennett Rd
Culpeper, VA 22701
Phone (540) 727-0737

1516 S Main St
Farmville, VA 23901
Phone (434) 326-0209

10504 Wakeman Dr
Fredericksburg, VA 22407
Phone (540) 315-8249

115 Jefferson Hwy
Ste 102
Louisa, VA 23093
Phone (540) 967-1757

4208 Franklin Rd SW
#B
Roanoke, VA 24014
Phone (540) 446-0189

138 Stoneridge Dr N
Ste 4
Ruckersville, VA 22968
Phone (434) 985-2288

150 Burnetts Way
Ste 230
Suffolk, VA 23434
Phone (757) 942-2022

1561 Commerce Rd
#402
Verona, VA 24482
Phone (540) 416-0110

1628 Laskin Rd
Ste 706
Virginia Beach, VA 23451
Phone (757) 481-0052

2076 S Independence Blvd
Ste A
Virginia Beach, VA 23453
Phone (757) 302-4144

2117 McComas Way
Ste 105
Virginia Beach, VA 23456
Phone (757) 427-5505

4421 Virginia Beach Blvd
Ste 101
Virginia Beach, VA 23462
Phone (757) 932-2390

100 Community Dr
#B
Waynesboro, VA 22980
Phone (540) 932-0333

Practitioners & affiliated clinicians

Practitioners 373

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 373

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1982657433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412307",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412307",
            "telephone_number": "914-294-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 PROVIDENCE RD",
            "address_2": "SUITE 80",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234644128",
            "telephone_number": "757-467-4604",
            "fax_number": "757-467-2716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVYREHAB SEPT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "914-294-4050"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHEASTERN PHYSICAL THERAPY",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.