DERICK M RUSSELL Physical Therapist License verification

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070013337

License Status

ACTIVE

Business

First Name

DERICK

Middle

Last Name

RUSSELL

Business Name

DERICK M RUSSELL

Original Issue Date

12/20/2002

Effective Date

09/15/2024

Expiration Date

09/30/2026

City

FOREST PARK

State

Zip

60130

County

COOK

Ever Disciplined

LastModifiedDate

09/15/2024