LANE D DIECKOW Physical Therapist License verification

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070016884

License Status

ACTIVE

Business

First Name

LANE

Middle

Last Name

DIECKOW

Business Name

LANE D DIECKOW

Original Issue Date

01/27/2009

Effective Date

08/22/2024

Expiration Date

09/30/2026

City

MAPLETON

State

Zip

61547

County

PEORIA

Ever Disciplined

LastModifiedDate

08/22/2024