KYLE J WAGNER Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070022159

License Status

NOT RENEWED

Business

First Name

KYLE

Middle

Last Name

WAGNER

Business Name

KYLE J WAGNER

Original Issue Date

05/27/2016

Effective Date

09/19/2018

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60657

County

NEW YORK

Ever Disciplined

LastModifiedDate

01/14/2021