Healthcare Provider Details

I. General information

NPI: 1235354366
Provider Name (Legal Business Name): KERRY F RAIVEL PT, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N MAIN ST BLDG 3
LEEDS MA
01053-9700
US

IV. Provider business mailing address

18 W CENTER ST
FLORENCE MA
01062-1210
US

V. Phone/Fax

Practice location:
  • Phone: 413-687-4233
  • Fax:
Mailing address:
  • Phone: 212-781-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18552
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: