EMMA MADISON WALLACE Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070024825

License Status

NOT RENEWED

Business

First Name

EMMA

Middle

MADISON

Last Name

WALLACE

Business Name

EMMA MADISON WALLACE

Original Issue Date

11/05/2019

Effective Date

11/05/2019

Expiration Date

09/30/2020

City

CARMEL

State

Zip

93923

Ever Disciplined

LastModifiedDate

01/14/2021