Provider Demographics
NPI:1386849875
Name:VANDER WALL, JOEL ANDREW (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:ANDREW
Last Name:VANDER WALL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1465 64TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315
Mailing Address - Country:US
Mailing Address - Phone:616-257-3014
Mailing Address - Fax:616-735-6344
Practice Address - Street 1:3863 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534
Practice Address - Country:US
Practice Address - Phone:616-735-4545
Practice Address - Fax:616-735-6344
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5501010049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist