KATELIN VIRGINIA PROVOST Physical Therapist License verification

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070018860

License Status

ACTIVE

Business

First Name

KATELIN

Middle

VIRGINIA

Last Name

PROVOST

Business Name

KATELIN VIRGINIA PROVOST

Original Issue Date

11/07/2011

Effective Date

09/19/2024

Expiration Date

09/30/2026

City

STERLING

State

Zip

61081

County

WHITESIDE

Ever Disciplined

LastModifiedDate

09/19/2024