JACOBUS A WELLERDIECK Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070008643

License Status

NOT RENEWED

Business

First Name

JACOBUS A

Last Name

WELLERDIECK

Business Name

JACOBUS A WELLERDIECK

Original Issue Date

01/31/1995

Effective Date

08/05/2020

Expiration Date

09/30/2022

City

EAST GALESBURG

State

Zip

61430

County

KNOX

Ever Disciplined

LastModifiedDate

11/28/2022