SUPA PONGLORPISIT - Physical Therapist License in Illinois | # 070004357

SUPA PONGLORPISIT

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070004357

License Status

INACTIVE

Business

N

First Name

SUPA

Last Name

PONGLORPISIT

Business Name

SUPA PONGLORPISIT

Original Issue Date

12/28/1984

Effective Date

10/01/2006

Expiration Date

09/30/2008

State

IL

Ever Disciplined

N

LastModifiedDate

07/10/2008