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:
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 1:4 RICHMOND SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:
Practice Address - Street 1:1395 COMMERCE WAY STE 112
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-4695
Practice Address - Country:US
Practice Address - Phone:508-455-5740
Practice Address - Fax:508-455-5945
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2025-04-30
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
MAY68372OtherBLUE CROSS BLUE SHIELD
MA470237OtherTUFTS
MAY68372OtherBLUE CROSS BLUE SHIELD