Provider Demographics
NPI:1821194838
Name:TRIVERI, KYLA A (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KYLA
Middle Name:A
Last Name:TRIVERI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:A
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2300 CROWN COLONY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0902
Mailing Address - Country:US
Mailing Address - Phone:781-986-0990
Mailing Address - Fax:781-986-0991
Practice Address - Street 1:502 GRANITE AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5610
Practice Address - Country:US
Practice Address - Phone:857-228-0090
Practice Address - Fax:781-986-0991
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA470237OtherTUFTS
MAY68372OtherBLUE CROSS BLUE SHIELD
MAY68372OtherBLUE CROSS BLUE SHIELD