Individual provider Active NPI

Angelika Faith Pel Agahan, PT

  • Physical Therapist
  • Jackson, CA
National Provider Identifier
1003550583
Registry record updated Mar 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
301977 Issued in CA
Practice address
12150 Industry Blvd Ste 42
Jackson, CA 95642-9375
Phone
(530) 223-9410
NPI assigned
Apr 21, 2022
Last updated
Mar 19, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 301977 CA Primary

Addresses

Primary practice location

12150 Industry Blvd Ste 42
Jackson, CA 95642-9375

Mailing address

1252 Broadway
Placerville, CA 95667-5822
Phone (530) 223-9410

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Clinicient

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220610000479 CA Practitioner - Physical Therapist in Private Practice 8820476401 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians

Practice addresses (Care Compare)

16185 Los Gatos Blvd
Suite 205
Los Gatos, CA 95032-4569
Phone (866) 525-3175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Fitzpatrick Physical Therapy Inc. Physical Therapist CurrentSince Apr 21, 2022 Accepting new patients
MDRS Spine & Sport, Inc Physical Therapist CurrentSince Oct 30, 2023 Accepting new patients
MDRS Spine & Sport, Inc Physical Therapist CurrentSince Oct 30, 2023 Accepting new patients

Locations

450 Rosewood Ave
Ste 105
Camarillo, CA 93010
Phone (805) 389-4781

1020 Tierra del Rey
Ste A1
Chula Vista, CA 91910
Phone (619) 585-7104

14150 Culver Dr
Ste 103
Irvine, CA 92604
Phone (949) 262-9142

12150 Industry Blvd
Ste 42
Jackson, CA 95642
Phone (209) 223-9410

2240 E Plaza Blvd
Ste Be
National City, CA 91950
Phone (619) 474-5916

1252 Broadway
Placerville, CA 95667
Phone (318) 680-8208

1252 Broadway
Ste B
Placerville, CA 95667
Phone (530) 622-9410

9852 Business Park Dr
Ste A
Sacramento, CA 95827
Phone (916) 362-7962

1801 Cleveland Ave
Ste B
Santa Rosa, CA 95401
Phone (707) 526-4180

5850 Canoga Ave
Ste 120
Woodland Hills, CA 91367
Phone (747) 255-4089

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1003550583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1252 BROADWAY",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675822",
            "telephone_number": "530-223-9410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12150 INDUSTRY BLVD STE 42",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956429375",
            "telephone_number": "530-223-9410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGAHAN",
        "first_name": "ANGELIKA FAITH",
        "middle_name": "PEL",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-21",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "301977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Clinicient",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "address_1": "1252 Broadway",
            "city": "Placerville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956675822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.