Basic Information
| Provider Information | |||||||||
| NPI: | 1518105279 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IVYREHAB FOCUS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 MAMARONECK AVE STE 140 | ||||||||
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| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106055224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142944050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 439 CHANNEL RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | LAKE WYLIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297106101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037467800 | ||||||||
| FaxNumber: | 8037467807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2009 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | RUCKER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9147778700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.