JERRY L SUPANCIC Physical Therapist License verification

Business Entity

ACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160001633

License Status

ACTIVE

Business

First Name

JERRY L

Last Name

SUPANCIC

Business Name

JERRY L SUPANCIC

Original Issue Date

01/20/1993

Effective Date

09/23/2025

Expiration Date

09/30/2027

City

BENTON

State

Zip

62812

Ever Disciplined

LastModifiedDate

09/23/2025