Individual
MATTHEW RAY DEWALL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MPT CSCS
Contact information
Practice address
1507 NORTH 1ST ST, INDIANOLA, IA 50125
(515) 382-3366
(515) 382-1576
Mailing address
PO BOX 461, NEVADA, IA 50201-0461
(515) 382-3366
(515) 382-1576
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
03373
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36592
BCBS IND
IA
01
—
46363
BCBS GR & MADRID
IA
01
—
46364
BCBS AH
IA
Enumeration date
04/27/2006
Last updated
07/08/2007
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