HETAL R SHAH Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070014190

License Status

NOT RENEWED

Business

First Name

HETAL

Middle

Last Name

SHAH

Business Name

HETAL R SHAH

Original Issue Date

10/21/2004

Effective Date

07/16/2008

Expiration Date

09/30/2010

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/08/2010