MONA R BLAINE Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160002855

License Status

INACTIVE

Business

First Name

MONA R

Last Name

BLAINE

Business Name

MONA R BLAINE

Original Issue Date

10/23/1997

Effective Date

09/30/2005

Expiration Date

09/30/2007

City

EUREKA

State

Zip

63025

County

MISSOURI

Ever Disciplined

LastModifiedDate

07/05/2007