KELLY J BLACK Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070005822

License Status

NOT RENEWED

Business

First Name

KELLY J

Last Name

BLACK

Business Name

KELLY J BLACK

Original Issue Date

10/31/1989

Effective Date

10/31/1989

Expiration Date

09/30/1990

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/14/2005