DIANE M FORNEK Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160004267

License Status

NOT RENEWED

Business

First Name

DIANE

Middle

Last Name

FORNEK

Business Name

DIANE M FORNEK

Original Issue Date

02/05/2004

Effective Date

08/01/2019

Expiration Date

01/31/2022

City

NAPERVILLE

State

Zip

60564

County

WILL

Ever Disciplined

LastModifiedDate

05/19/2022