TYLER VAN BASTIAN DPT - Physical Therapist License in New Mexico | # 070026564

TYLER VAN BASTIAN DPT

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070026564

License Status

NOT RENEWED

Business

N

Title

DPT

First Name

TYLER

Last Name

VAN BASTIAN

Business Name

TYLER VAN BASTIAN DPT

Original Issue Date

05/04/2022

Effective Date

05/04/2022

Expiration Date

09/30/2022

State

NM

Ever Disciplined

N

LastModifiedDate

11/28/2022