TIFFANY A BOULWARE Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070011122

License Status

NOT RENEWED

Business

First Name

TIFFANY

Middle

Last Name

BOULWARE

Business Name

TIFFANY A BOULWARE

Original Issue Date

01/29/1999

Effective Date

09/30/2004

Expiration Date

09/30/2006

City

CONYERS

State

Zip

30013

County

GEORGIA

Ever Disciplined

LastModifiedDate

11/08/2006