Individual
ELENA IGOREVNA SUTPHIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1936 OPITZ BLVD STE A, WOODBRIDGE, VA 22191-3360
(540) 841-4443
Mailing address
35332 QUAIL MEADOW LN, LOCUST GROVE, VA 22508-3116
(929) 272-6742
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2306605532
VA
2081P0010X
Pediatric Rehabilitation Medicine Physician
2306605532
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2306605532
VA DEPARTMENT OF HEALTH PROFESSIONALS/BOARD OF PHYSICAL THERAPY
VA
Enumeration date
10/09/2020
Last updated
10/09/2020
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