Healthcare Provider Details

I. General information

NPI: 1255299277
Provider Name (Legal Business Name): ALYTA TERRELL ELECTROLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6170 LEHMAN DR STE 105
COLORADO SPRINGS CO
80918-3443
US

IV. Provider business mailing address

6170 LEHMAN DR STE 105
COLORADO SPRINGS CO
80918-3443
US

V. Phone/Fax

Practice location:
  • Phone: 719-744-3425
  • Fax:
Mailing address:
  • Phone: 719-744-3425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number14245106-1103
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14245106-1103
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: