MEDICARE: KATRINA RAEANN SUDIA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	308997	CA

General Provider Information

NPI Number	:	1295609550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA RAEANN SUDIA DPT

Provider Business Mailing Address
First Line	:	475 PIONEER AVE # 200
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95776-4905
Country	:	US
Telephone Number	:	530-406-5620
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 PIONEER AVE STE 200
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95776-4905
Country	:	US
Telephone Number	:	530-406-5620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	03/10/2026

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Directions to “ KATRINA RAEANN SUDIA DPT” Practice Location

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