TIFFANY A BOULWARE - Physical Therapist License in Georgia | # 070011122

TIFFANY A BOULWARE

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070011122

License Status

NOT RENEWED

Business

N

First Name

TIFFANY

Middle

A

Last Name

BOULWARE

Business Name

TIFFANY A BOULWARE

Original Issue Date

01/29/1999

Effective Date

09/30/2004

Expiration Date

09/30/2006

State

GA

Ever Disciplined

N

LastModifiedDate

11/08/2006