CAROLYN E WAGNER Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160003770

License Status

NOT RENEWED

Business

First Name

CAROLYN

Middle

Last Name

WAGNER

Business Name

CAROLYN E WAGNER

Original Issue Date

12/13/2000

Effective Date

12/13/2000

Expiration Date

09/30/2005

City

ROCKFORD

State

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/17/2005