{"npi":"1225868680","type":"NPI-2","status":"active","name":{"display":"Revitalife Pt LLC","other":[],"organization_name":"REVITALIFE PT LLC","authorised_official":"Mitali Mohanan"},"specialty":{"primary_taxonomy":"261Q00000X","primary_taxonomy_description":"Clinic/Center","slug":"clinic-center","schema_org_specialty":null,"all":[{"code":"261Q00000X","description":"Clinic/Center","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"3 POND ST","city":"MENDON","state":"MA","postal_code":"017564500","country_code":"US","phone":"7742938674"},{"purpose":"MAILING","street_1":"3 POND ST","city":"MENDON","state":"MA","postal_code":"017564500","country_code":"US"}],"license":null,"identifiers":[],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20240813003179","type_code":"12-65","type_desc":"PART B SUPPLIER - PHYSICAL/OCCUPATIONAL THERAPY GROUP IN PRIVATE PRACTICE","state":"MA","pac_id":"4789122417"}]},"enumeration_date":"2024-08-01","last_updated":"2024-08-01","_meta":{"source":"NPPES","snapshot_date":"2024-08-01","doc_url":"https://findmynpi.com/api"}}