MIBSAM LISSETTE HERRERA - Physical Therapist License in Illinois | # 160004415

MIBSAM LISSETTE HERRERA

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160004415

License Status

NOT RENEWED

Business

N

First Name

MIBSAM

Middle

LISSETTE

Last Name

HERRERA

Business Name

MIBSAM LISSETTE HERRERA

Original Issue Date

03/24/2005

Effective Date

09/30/2005

Expiration Date

09/30/2007

State

IL

Ever Disciplined

N

LastModifiedDate

03/25/2008