LISA MARIE VANDER BLOOMER - Physical Therapist License in Wisconsin | # 070012506

LISA MARIE VANDER BLOOMER

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070012506

License Status

NOT RENEWED

Business

N

First Name

LISA

Middle

MARIE

Last Name

VANDER BLOOMER

Business Name

LISA MARIE VANDER BLOOMER

Original Issue Date

06/06/2001

Effective Date

06/06/2001

Expiration Date

09/30/2002

State

WI

Ever Disciplined

N

LastModifiedDate

10/17/2005