SUSAN R PROVOST Physical Therapist License verification

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070011402

License Status

ACTIVE

Business

First Name

SUSAN

Middle

Last Name

PROVOST

Business Name

SUSAN R PROVOST

Original Issue Date

07/30/1999

Effective Date

09/17/2024

Expiration Date

09/30/2026

City

FRANKFORT

State

Zip

60423

County

WILL

Ever Disciplined

LastModifiedDate

09/17/2024