Provider Demographics
NPI:1891185757
Name:BROCKENBROUGH, ASHTON (ATC)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:BROCKENBROUGH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10412 ROANOKE RD
Mailing Address - Street 2:
Mailing Address - City:ELLISTON
Mailing Address - State:VA
Mailing Address - Zip Code:24087-2333
Mailing Address - Country:US
Mailing Address - Phone:540-589-5024
Mailing Address - Fax:
Practice Address - Street 1:2902 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-1314
Practice Address - Country:US
Practice Address - Phone:540-562-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer