| Doctor Name: | MRS. MYRNA RAE VAN DE WALLE |
| NPI Number: | 1083760755 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHYSICAL THERAPIST |
| License Number: | 00694 |
| Business Practice Address: | 9184 265th St Suite B Clear Lake, IA - 504288507 |
| Business Phone Number: | 6413576112 |
| Business Fax Number: | 6413573686 |
| Mailing Address: | 609 S Tennessee Pl, MASON CITY |
| State: | IA |
| Postal Code: | 504015358 |
| Phone Number: | 6414246042 |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 00694 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |