Provider Demographics
NPI:1003550583
Name:PEL, ANGELIKA FAITH (PT)
Entity Type:Individual
Prefix:
First Name:ANGELIKA
Middle Name:FAITH
Last Name:PEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5822
Mailing Address - Country:US
Mailing Address - Phone:530-223-9410
Mailing Address - Fax:
Practice Address - Street 1:12150 INDUSTRY BLVD STE 42
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9375
Practice Address - Country:US
Practice Address - Phone:530-223-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist