Provider Demographics
NPI:1164812640
Name:SUTTMILLER, ASHLEY MARIE BRAWFORD (ATC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE BRAWFORD
Last Name:SUTTMILLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:BRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:5408 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2893
Mailing Address - Country:US
Mailing Address - Phone:757-220-8552
Mailing Address - Fax:
Practice Address - Street 1:5408 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2893
Practice Address - Country:US
Practice Address - Phone:757-220-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260014342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer