GORDON K GREEN Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070004702

License Status

NOT RENEWED

Business

First Name

GORDON K

Last Name

GREEN

Business Name

GORDON K GREEN

Original Issue Date

01/15/1986

Effective Date

08/14/2018

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/14/2021