Provider Demographics
NPI:1558474056
Name:RAYEV, IZABELLA (PT)
Entity Type:Individual
Prefix:
First Name:IZABELLA
Middle Name:
Last Name:RAYEV
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4500
Mailing Address - Country:US
Mailing Address - Phone:617-734-6135
Mailing Address - Fax:617-734-3744
Practice Address - Street 1:637 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4500
Practice Address - Country:US
Practice Address - Phone:617-734-6135
Practice Address - Fax:617-734-3744
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0308641Medicaid
MAY6850201Medicare PIN