Elena Igorevna Sutphin, PTA

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

2306605532 Issued in VA

Practice address

1936 Opitz Blvd Ste a
Woodbridge, VA 22191-3360

Phone

(540) 841-4443

NPI assigned

Oct 9, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602201600000",
    "number": "1134727357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35332 QUAIL MEADOW LN",
            "city": "LOCUST GROVE",
            "state": "VA",
            "postal_code": "225083116",
            "telephone_number": "929-272-6742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1936 OPITZ BLVD STE A",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913360",
            "telephone_number": "540-841-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTPHIN",
        "first_name": "ELENA",
        "middle_name": "IGOREVNA",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-09",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
            "state": "VA",
            "license": "2306605532",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "2306605532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA DEPARTMENT OF HEALTH PROFESSIONALS/BOARD OF PHYSICAL THERAPY",
            "identifier": "2306605532",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lawrence E. Sutton, L.P.C.
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• Tykeeya M Sweet
• Brad B Swelstad, MD
• Synergy Medical Group Im LLC

• Physical Medicine & Rehabilitation Physician in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Physical Medicine & Rehabilitation Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.