Revitalife Pt Llc is a medicare enrolled primary clinic (Clinic/center) in Mendon, Massachusetts. The current practice location for Revitalife Pt Llc is 3 Pond St, Mendon, Massachusetts. For appointments, you can reach them via phone at
(774) 293-8674. The mailing address for Revitalife Pt Llc is 3 Pond St, Mendon, Massachusetts and phone number is () -.
Revitalife Pt Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its
NPI number is 1225868680. This medical practice
accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at
(774) 293-8674.
Primary Care Clinic Profile
| Full Name | Revitalife Pt Llc |
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| Speciality | Clinic/Center |
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| Location | 3 Pond St, Mendon, Massachusetts |
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| Authorized Official Name and Position | Mitali Mohanan (PT) |
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| Authorized Official Contact | 7742938674 |
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| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Revitalife Pt Llc
3 Pond St
Mendon
MA 01756-4500
Ph: () - | Revitalife Pt Llc
3 Pond St
Mendon
MA 01756-4500
Ph: (774) 293-8674 |
NPI Details:
| NPI Number | 1225868680 |
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| Provider Enumeration Date | 08/01/2024 |
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| Last Update Date | 08/01/2024 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 4789122417 |
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| Medicare Enrollment ID | O20240813003179 |
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Medical Identifiers
Medical identifiers for Revitalife Pt Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1225868680 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Revitalife Pt Llc acts as a billing entity for following providers:
| Provider Name | Mitali Mohanan |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1255182036
PECOS PAC ID: 5698213320
Enrollment ID: I20240813003237 |
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