MEDICARE: MIA GRACE NEADERHISER

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	225100000X	Physical Therapist	PTL.0021316	CO

General Provider Information

NPI Number	:	1629900980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA GRACE NEADERHISER

Provider Business Mailing Address
First Line	:	12317 W 101ST ST
Second Line	:
City	:	LENEXA
State	:	KS
Zip	:	66215-1909
Country	:	US
Telephone Number	:	913-579-3205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 MEDICAL CENTER PT STE 180
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-5798
Country	:	US
Telephone Number	:	719-344-9497
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ MIA GRACE NEADERHISER ” Practice Location

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