Provider Demographics
NPI:1093329559
Name:SUDDUTH, KATRINA (DPT, NCS)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:SUDDUTH
Suffix:
Gender:F
Credentials:DPT, NCS
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:DEWEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12740 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4308
Mailing Address - Country:US
Mailing Address - Phone:360-521-2562
Mailing Address - Fax:
Practice Address - Street 1:12740 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4308
Practice Address - Country:US
Practice Address - Phone:360-521-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00137032251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology