MARTHA C DERLETH Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070001819

License Status

INACTIVE

Business

First Name

MARTHA C

Last Name

DERLETH

Business Name

MARTHA C DERLETH

Original Issue Date

05/06/1974

Effective Date

05/06/1974

Expiration Date

09/30/2002

City

GURNEE

State

Zip

60031

County

LAKE

Ever Disciplined

LastModifiedDate

10/17/2005