Provider Demographics
NPI:1003858374
Name:RAFFERTY, KEVIN L (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:RAFFERTY
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 1:116 DANBURY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3442
Mailing Address - Country:US
Mailing Address - Phone:860-799-6320
Mailing Address - Fax:860-799-6621
Practice Address - Street 1:425 S BROAD ST
Practice Address - Street 2:UNIT 1
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450
Practice Address - Country:US
Practice Address - Phone:203-238-1334
Practice Address - Fax:203-238-1351
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004170586Medicaid