JENNY DARICE CAPOUCH - Physical Therapist License in Wisconsin | # 160004638

JENNY DARICE CAPOUCH

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160004638

License Status

NOT RENEWED

Business

N

First Name

JENNY

Middle

DARICE

Last Name

CAPOUCH

Business Name

JENNY DARICE CAPOUCH

Original Issue Date

09/12/2006

Effective Date

09/29/2009

Expiration Date

09/30/2011

State

WI

Ever Disciplined

N

LastModifiedDate

11/04/2011