DAVID A BLACK Physical Therapist License verification

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070006923

License Status

ACTIVE

Business

First Name

DAVID A

Last Name

BLACK

Business Name

DAVID A BLACK

Original Issue Date

04/27/1992

Effective Date

09/11/2024

Expiration Date

09/30/2026

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/11/2024