DANIEL E BOOSTROM Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160004378

License Status

NOT RENEWED

Business

First Name

DANIEL

Middle

Last Name

BOOSTROM

Business Name

DANIEL E BOOSTROM

Original Issue Date

11/29/2004

Effective Date

07/05/2007

Expiration Date

09/30/2009

City

MISSOULA

State

Zip

59801

County

MONTANA

Ever Disciplined

LastModifiedDate

11/04/2009