ERIN M FASULA Physical Therapist License verification

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070016144

License Status

ACTIVE

Business

First Name

ERIN

Middle

Last Name

FASULA

Business Name

ERIN M FASULA

BusinessDBA

CHURCH

Original Issue Date

12/12/2007

Effective Date

09/28/2024

Expiration Date

09/30/2026

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/28/2024