Healthcare Provider Details

I. General information

NPI: 1366364051
Provider Name (Legal Business Name): NICOLE PISCATELLA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42080 STATE ST STE A
PALM DESERT CA
92211-5173
US

IV. Provider business mailing address

42080 STATE ST STE A
PALM DESERT CA
92211-5173
US

V. Phone/Fax

Practice location:
  • Phone: 760-568-2894
  • Fax: 760-346-4179
Mailing address:
  • Phone: 760-568-2894
  • Fax: 760-346-4179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA550015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: