TERENCE LEON TYDEREK Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070002174

License Status

NOT RENEWED

Business

First Name

TERENCE LEON

Last Name

TYDEREK

Business Name

TERENCE LEON TYDEREK

Original Issue Date

04/16/1976

Effective Date

08/06/2014

Expiration Date

09/30/2016

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

11/26/2016