SHASTA M MCCULLA Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160005027

License Status

NOT RENEWED

Business

First Name

SHASTA

Middle

Last Name

MCCULLA

Business Name

SHASTA M MCCULLA

Original Issue Date

08/25/2008

Effective Date

09/15/2023

Expiration Date

09/30/2025

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

12/30/2025