TRACI A DIVELEY Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160001168

License Status

NOT RENEWED

Business

First Name

TRACI A

Last Name

DIVELEY

Business Name

TRACI A DIVELEY

Original Issue Date

12/16/1991

Effective Date

08/05/2019

Expiration Date

01/31/2022

City

CHILLICOTHE

State

Zip

61523

County

PEORIA

Ever Disciplined

LastModifiedDate

05/19/2022