Healthcare Provider Details

I. General information

NPI: 1104747518
Provider Name (Legal Business Name): AYANA PEDRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 S CIRCLE DR STE 250
COLORADO SPRINGS CO
80906-4132
US

IV. Provider business mailing address

1716 LORRAINE ST APT B2
COLORADO SPRINGS CO
80905-2180
US

V. Phone/Fax

Practice location:
  • Phone: 719-900-3009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0005804
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: