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General NPI Number Information
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NPI Number | 1629900980
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Entity Type | Individual
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Provider Name | MIA GRACE NEADERHISER
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Gender | Female
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 1625 MEDICAL CENTER PT STE 180
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-5798
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Country | US
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Telephone | 719-344-9497
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Fax |
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Provider Business Mailing Address
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Address Line | 12317 W 101ST ST
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City | LENEXA
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State | KS
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Zip | 66215-1909
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Country | US
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Telephone | 913-579-3205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0021316
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License Number State | CO
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