BROOKE A WAGENBACH Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160005680

License Status

INACTIVE

Business

First Name

BROOKE

Middle

Last Name

WAGENBACH

Business Name

BROOKE A WAGENBACH

Original Issue Date

07/05/2011

Effective Date

07/05/2011

Expiration Date

09/30/2013

City

ELMWOOD

State

Zip

61529

County

PEORIA

Ever Disciplined

LastModifiedDate

07/03/2013