Provider Demographics
NPI:1962216853
Name:NEDDERMEYER, AVA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:MARIE
Last Name:NEDDERMEYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E 16TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1637
Mailing Address - Country:US
Mailing Address - Phone:480-559-4022
Mailing Address - Fax:
Practice Address - Street 1:5670 GREENWOOD PLAZA BLVD STE LI110
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2448
Practice Address - Country:US
Practice Address - Phone:303-694-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty