CAROLYN WAGNER FAGAN Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070002824

License Status

NOT RENEWED

Business

First Name

CAROLYN WAGNER

Last Name

FAGAN

Business Name

CAROLYN WAGNER FAGAN

Original Issue Date

12/18/1978

Effective Date

12/18/1978

Expiration Date

09/30/1990

City

SANTA FE

State

Zip

87505

County

NEW MEXICO

Ever Disciplined

LastModifiedDate

10/14/2005