JILLENE M BLOMBERG Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160002710

License Status

NOT RENEWED

Business

First Name

JILLENE M

Last Name

BLOMBERG

Business Name

JILLENE M BLOMBERG

Original Issue Date

04/21/1997

Effective Date

08/17/2017

Expiration Date

09/30/2019

City

SHERMAN

State

Zip

62684

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/13/2020