KRISTA M FORMANEK Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070016736

License Status

NOT RENEWED

Business

First Name

KRISTA

Middle

Last Name

FORMANEK

Business Name

KRISTA M FORMANEK

Original Issue Date

09/30/2008

Effective Date

09/30/2008

Expiration Date

09/30/2010

City

WHEELING

State

Zip

60090

County

COOK

Ever Disciplined

LastModifiedDate

11/08/2010