JOHN MARK WAGNER Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070003107

License Status

NOT RENEWED

Business

First Name

JOHN MARK

Last Name

WAGNER

Business Name

JOHN MARK WAGNER

Original Issue Date

12/24/1979

Effective Date

12/24/1979

Expiration Date

08/01/1982

City

HAZEL CREST

State

Zip

60429

County

COOK

Ever Disciplined

LastModifiedDate

10/14/2005