PHILLIP EDWARD WHITESIDE Orthotist, Prosthetist, and Pedorthist License verification

Business Entity

NOT RENEWED

License Type

Orthotist, Prosthetist, and Pedorthist

Description

LICENSED ORTHOTIST

License Number

213000209

License Status

NOT RENEWED

Business

First Name

PHILLIP

Middle

EDWARD

Last Name

WHITESIDE

Business Name

PHILLIP EDWARD WHITESIDE

Original Issue Date

03/30/2004

Effective Date

08/08/2019

Expiration Date

01/31/2022

City

NORMAL

State

Zip

61761

County

MCLEAN

Ever Disciplined

LastModifiedDate

05/18/2022