Revitalife PT LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

REVITALIFE PT LLC

Practice address

3 Pond St
Mendon, MA 01756-4500

Phone

(774) 293-8674

NPI assigned

Aug 1, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mitali MohananNPI 1255182036

Title

PT

Phone

(774) 293-8674

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mitali Mohanan, MPT

  • Physical Therapist
  • Mendon, MA
  • NPI 1255182036
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1225868680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 POND ST",
            "city": "MENDON",
            "state": "MA",
            "postal_code": "017564500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 POND ST",
            "city": "MENDON",
            "state": "MA",
            "postal_code": "017564500",
            "telephone_number": "774-293-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIFE PT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-01",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "MOHANAN",
        "authorized_official_first_name": "MITALI",
        "authorized_official_title_or_position": "PT",
        "authorized_official_telephone_number": "774-293-8674"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian M Minsk, M.D.
• Mitali Mohanan, MPT
• Christina Lyn Morrison, RD
• Margaret Kimberly Noyes, MSW
• Charlene A Remillard, LICSW
• Sandra Ann Abdelahad
• Sherri Ellen Snyder, MA
• Sterling Counseling Services, LLC
• Allison Kelleher Sullivan
• Joanne Taub, LICSW

• Clinic/Center in Mendon, MA
• Providers in Mendon, MA by specialty
• Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.