LAILANI FONTANILLA PONCE Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070019558

License Status

NOT RENEWED

Business

First Name

LAILANI

Middle

FONTANILLA

Last Name

PONCE

Business Name

LAILANI FONTANILLA PONCE

Original Issue Date

11/01/2012

Effective Date

07/07/2018

Expiration Date

09/30/2020

City

JACKSONVILLE

State

Zip

28546

County

NORTH CAROLINA

Ever Disciplined

LastModifiedDate

01/14/2021