Pitacle Fairy Incorporated

NPI #1255500302 in Simi Valley, California

Provider Information

NPI Number: 1255500302
Entity Type: Organization
Organization Name: Pitacle Fairy Incorporated
Primary Specialty: Physical Therapist
Enumeration Date: Feb 22, 2008
Last Updated: Feb 22, 2008

Practice Location

Address: 1115 E LOS ANGELES AVE
City: Simi Valley
State: California
ZIP Code: 93065-2801
Phone: (806) 306-1840

Authorized Official

Name: MR. JOHN J MANDEL
Title: PRESIDENT
Phone: (805) 306-1840

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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