Healthcare Provider Details

I. General information

NPI: 1841001971
Provider Name (Legal Business Name): REVITA WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11804 PARADE DR
FRISCO TX
75036-1020
US

IV. Provider business mailing address

11804 PARADE DR
FRISCO TX
75036-1020
US

V. Phone/Fax

Practice location:
  • Phone: 972-313-5017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: SHEEBA MATHAI
Title or Position: NP
Credential:
Phone: 972-313-5017