CAROLYN WAGNER FAGAN - Physical Therapist License in New Mexico | # 070002824

CAROLYN WAGNER FAGAN

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070002824

License Status

NOT RENEWED

Business

N

First Name

CAROLYN WAGNER

Last Name

FAGAN

Business Name

CAROLYN WAGNER FAGAN

Original Issue Date

12/18/1978

Effective Date

12/18/1978

Expiration Date

09/30/1990

State

NM

Ever Disciplined

N

LastModifiedDate

10/14/2005