AMANDA MELISSA BRACKROG Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070022107

License Status

NOT RENEWED

Business

First Name

AMANDA

Middle

MELISSA

Last Name

BRACKROG

Business Name

AMANDA MELISSA BRACKROG

Original Issue Date

03/29/2016

Effective Date

07/22/2016

Expiration Date

09/30/2018

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

12/05/2018