THEODORE W FOGELSTROM - Physical Therapist License in Illinois | # 160001303

THEODORE W FOGELSTROM

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160001303

License Status

INACTIVE

Business

N

First Name

THEODORE W

Last Name

FOGELSTROM

Business Name

THEODORE W FOGELSTROM

Original Issue Date

01/03/1992

Effective Date

01/03/1992

Expiration Date

09/30/2005

State

IL

Ever Disciplined

N

LastModifiedDate

10/17/2005