AGNES L VAN DE PUT Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070009369

License Status

INACTIVE

Business

First Name

AGNES L

Last Name

VAN DE PUT

Business Name

AGNES L VAN DE PUT

Original Issue Date

02/14/1996

Effective Date

02/14/1996

Expiration Date

09/30/2004

City

KAILUA-KONA

State

Zip

96740

County

HAWAII

Ever Disciplined

LastModifiedDate

09/01/2006