WILLIAM J PROVOST - Physical Therapist License in Illinois | # 160001028

WILLIAM J PROVOST

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160001028

License Status

NOT RENEWED

Business

N

First Name

WILLIAM J

Last Name

PROVOST

Business Name

WILLIAM J PROVOST

Original Issue Date

11/23/1991

Effective Date

09/06/2023

Expiration Date

09/30/2025

State

IL

Ever Disciplined

N

LastModifiedDate

12/30/2025