BRENT D BETZOLD Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070012076

License Status

NOT RENEWED

Business

First Name

BRENT

Middle

Last Name

BETZOLD

Business Name

BRENT D BETZOLD

Original Issue Date

08/29/2000

Effective Date

08/29/2000

Expiration Date

09/30/2004

City

NORMAL

State

Zip

61761

County

MCLEAN

Ever Disciplined

LastModifiedDate

10/17/2005