NATHAN ROBERT BLAYLOCK Physical Therapist License verification

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070024249

License Status

ACTIVE

Business

First Name

NATHAN

Middle

ROBERT

Last Name

BLAYLOCK

Business Name

NATHAN ROBERT BLAYLOCK

Original Issue Date

04/01/2019

Effective Date

09/04/2024

Expiration Date

09/30/2026

City

VIENNA

State

Zip

62995

County

JOHNSON

Ever Disciplined

LastModifiedDate

09/04/2024