STACEY A BLAUSTEIN Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070009016

License Status

INACTIVE

Business

First Name

STACEY A

Last Name

BLAUSTEIN

Business Name

STACEY A BLAUSTEIN

Original Issue Date

09/06/1995

Effective Date

09/06/1995

Expiration Date

09/30/2002

City

SPRINGFIELD

State

Zip

62707

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/17/2005