SEAN MARK LABASTIDA SUPERTICIOSO Physical Therapist License verification

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070024159

License Status

ACTIVE

Business

First Name

SEAN MARK

Middle

LABASTIDA

Last Name

SUPERTICIOSO

Business Name

SEAN MARK LABASTIDA SUPERTICIOSO

Original Issue Date

02/06/2019

Effective Date

09/26/2024

Expiration Date

09/30/2026

City

CRYSTAL LAKE

State

Zip

60014

County

MCHENRY

Ever Disciplined

LastModifiedDate

09/26/2024