KIM E FONNER Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160002514

License Status

NOT RENEWED

Business

First Name

KIM E

Last Name

FONNER

Business Name

KIM E FONNER

Original Issue Date

10/19/1996

Effective Date

10/02/2017

Expiration Date

09/30/2019

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

01/13/2020