Provider Demographics
NPI:1295206951
Name:CURRY, IVAN VICTOR (PT)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:VICTOR
Last Name:CURRY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:333 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2622
Practice Address - Country:US
Practice Address - Phone:864-515-7580
Practice Address - Fax:864-515-7581
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2023-02-22
Deactivation Date:2021-05-04
Deactivation Code:
Reactivation Date:2021-06-25
Provider Licenses
StateLicense IDTaxonomies
NCP9511225100000X
SC4093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist