LANE D DIECKOW - Physical Therapist License in Illinois | # 070016884

LANE D DIECKOW

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070016884

License Status

ACTIVE

Business

N

First Name

LANE

Middle

D

Last Name

DIECKOW

Business Name

LANE D DIECKOW

Original Issue Date

01/27/2009

Effective Date

08/22/2024

Expiration Date

09/30/2026

State

IL

Ever Disciplined

N

LastModifiedDate

08/22/2024