Healthcare Provider Details

I. General information

NPI: 1407778871
Provider Name (Legal Business Name): VITALITY MANSFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 LEXINGTON AVE STE 6
MANSFIELD OH
44907-1579
US

IV. Provider business mailing address

625 LEXINGTON AVE STE 6
MANSFIELD OH
44907-1579
US

V. Phone/Fax

Practice location:
  • Phone: 419-989-4342
  • Fax: 419-522-1113
Mailing address:
  • Phone: 419-989-4342
  • Fax: 419-522-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MCRAE
Title or Position: CEO/OWNER
Credential: DO
Phone: 419-989-4342