Individual
MRS. MYRNA RAE VAN DE WALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
9184 265TH ST, SUITE B, CLEAR LAKE, IA 50428-8507
(641) 357-6112
(641) 357-3686
Mailing address
609 S TENNESSEE PL, MASON CITY, IA 50401-5358
(641) 424-6042
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
00694
IA
Other
Enumeration date
01/26/2007
Last updated
07/08/2007
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