TISHA L THELEN Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070010103

License Status

INACTIVE

Business

First Name

TISHA L

Last Name

THELEN

Business Name

TISHA L THELEN

Original Issue Date

05/03/1997

Effective Date

08/15/2018

Expiration Date

09/30/2020

City

EAST PEORIA

State

Zip

61611

County

WOODFORD

Ever Disciplined

LastModifiedDate

07/27/2020