MARK EDWARD PETTIS Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160006312

License Status

NOT RENEWED

Business

First Name

MARK

Middle

EDWARD

Last Name

PETTIS

Business Name

MARK EDWARD PETTIS

Original Issue Date

12/06/2012

Effective Date

09/24/2015

Expiration Date

09/30/2017

City

LA PORTE

State

Zip

46350

County

INDIANA

Ever Disciplined

LastModifiedDate

11/01/2017