DIANE M FORNEK - Physical Therapist License in Illinois | # 160004267

DIANE M FORNEK

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160004267

License Status

NOT RENEWED

Business

N

First Name

DIANE

Middle

M

Last Name

FORNEK

Business Name

DIANE M FORNEK

Original Issue Date

02/05/2004

Effective Date

08/01/2019

Expiration Date

01/31/2022

State

IL

Ever Disciplined

N

LastModifiedDate

05/19/2022