WILLIAM J PROVOST Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160001028

License Status

NOT RENEWED

Business

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

City

FRANKFORT

State

Zip

60423

County

WILL

Ever Disciplined

LastModifiedDate

12/30/2025