STEPHANIE INGRID BALLEZA GUMBAN - Physical Therapist License in New Jersey | # 070022007

STEPHANIE INGRID BALLEZA GUMBAN

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070022007

License Status

NOT RENEWED

Business

N

First Name

STEPHANIE

Middle

INGRID BALLEZA

Last Name

GUMBAN

Business Name

STEPHANIE INGRID BALLEZA GUMBAN

Original Issue Date

02/04/2016

Effective Date

09/26/2018

Expiration Date

09/30/2020

State

NJ

Ever Disciplined

N

LastModifiedDate

01/14/2021