AMANDA D SULLIVAN Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160004265

License Status

INACTIVE

Business

First Name

AMANDA

Middle

Last Name

SULLIVAN

Business Name

AMANDA D SULLIVAN

Original Issue Date

02/03/2004

Effective Date

10/01/2019

Expiration Date

12/31/2021

City

MAKANDA

State

Zip

62958

County

JACKSON

Ever Disciplined

LastModifiedDate

12/31/2021