Fairy Therapetuic PLLC

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

Legal business name

FAIRY THERAPETUIC PLLC

Practice address

6884 Piedmont Center PLZ
Gainesville, VA 20155-4035

Phone

(571) 284-7612

NPI assigned

Jun 10, 2026

Organization subpart

Yes

Parent organization

MYSTIC FLOW WELLNESS CENTERAs reported in NPPES

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

Authorized official

Name

Kassi Moore

Title

Relaxational Theraipst

Phone

(540) 571-1880

Specialties & licenses 9

Addresses

Locations

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

{
    "created_epoch": "1781049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781049600000",
    "number": "1194659631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31",
            "city": "BEALETON",
            "state": "VA",
            "postal_code": "227120031",
            "telephone_number": "540-571-1880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6884 PIEDMONT CENTER PLZ",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201554035",
            "telephone_number": "571-284-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRY THERAPETUIC PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MYSTIC FLOW WELLNESS CENTER",
        "enumeration_date": "2026-06-10",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "KASSI",
        "authorized_official_title_or_position": "RELAXATIONAL THERAIPST",
        "authorized_official_telephone_number": "540-571-1880"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WM1400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Nurse Massage Therapist (NMT)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "173C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Reflexologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health & Wellness Coach in Gainesville, VA
• Providers in Gainesville, VA by specialty
• Health & Wellness Coach in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.