Provider Demographics
NPI:1568716124
Name:SUNDSTROM, ASHLEY P (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:P
Last Name:SUNDSTROM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHELY
Other - Middle Name:
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:608 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3708
Mailing Address - Country:US
Mailing Address - Phone:615-695-7715
Mailing Address - Fax:615-695-1483
Practice Address - Street 1:141 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5088
Practice Address - Country:US
Practice Address - Phone:931-552-4340
Practice Address - Fax:931-552-0999
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9433225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic