Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PTL.0013703 | CO |
NPI | 1093329559 |
---|---|
Provider Name | Katrina Sudduth |
First Address | Lakewood, CO 80228-4308 |
Second Address | Lakewood, CO 80228-4308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2020 |
Last Update Date | 02/09/2020 |