MARY C LACK Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160006251

License Status

NOT RENEWED

Business

First Name

MARY

Middle

Last Name

LACK

Business Name

MARY C LACK

Original Issue Date

11/20/2012

Effective Date

08/15/2019

Expiration Date

01/31/2022

City

EAST MOLINE

State

Zip

61244

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

05/19/2022