| Doctor Name: | MRS. NICOLE J VANDERWIELE |
| NPI Number: | 1124211941 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT |
| License Number: | 070015873 |
| Business Practice Address: | 1824 Front Street Ste A Lynden, WA - 982648708 |
| Business Phone Number: | 3603540585 |
| Business Fax Number: | 3603541098 |
| Mailing Address: | 205 W Wacker Dr, Suite 1020 CHICAGO |
| State: | IL |
| Postal Code: | 606061216 |
| Phone Number: | 3126400329 |
| Fax Number: | |
| NPI Enumeration Date: | 08/24/2007 |
| NPI Last Update Date: | 12/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 070015873 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| 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 |