Provider Demographics
NPI:1861112765
Name:TERRELL, ALYSHA (PT)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALYSHA
Other - Middle Name:
Other - Last Name:DEL TORO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4304 ANSEL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0117
Mailing Address - Country:US
Mailing Address - Phone:707-334-4432
Mailing Address - Fax:
Practice Address - Street 1:15000 KENSINGTON PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1831
Practice Address - Country:US
Practice Address - Phone:657-859-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist