THEODORE W FOGELSTROM Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160001303

License Status

INACTIVE

Business

First Name

THEODORE W

Last Name

FOGELSTROM

Business Name

THEODORE W FOGELSTROM

Original Issue Date

01/03/1992

Effective Date

01/03/1992

Expiration Date

09/30/2005

City

DES PLAINES

State

Zip

60016

County

COOK

Ever Disciplined

LastModifiedDate

10/17/2005