DOMINIQUE R BAGBY Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160004348

License Status

NOT RENEWED

Business

First Name

DOMINIQUE

Middle

Last Name

BAGBY

Business Name

DOMINIQUE R BAGBY

Original Issue Date

09/23/2004

Effective Date

08/09/2011

Expiration Date

09/30/2013

City

OAK LAWN

State

Zip

60453

County

COOK

Ever Disciplined

LastModifiedDate

11/12/2013