BLAKE BANNER - Physical Therapist License in Indiana | # 070026352

BLAKE BANNER

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070026352

License Status

ACTIVE

Business

N

First Name

BLAKE

Last Name

BANNER

Business Name

BLAKE BANNER

Original Issue Date

11/15/2021

Effective Date

08/27/2024

Expiration Date

09/30/2026

State

IN

Ever Disciplined

N

LastModifiedDate

08/27/2024