SAMANA LAKE Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070005977

License Status

INACTIVE

Business

First Name

SAMANA

Last Name

LAKE

Business Name

SAMANA LAKE

Original Issue Date

03/09/1990

Effective Date

09/10/2018

Expiration Date

09/30/2020

City

ROCHESTER

State

Zip

14622

County

COOK

Ever Disciplined

LastModifiedDate

07/27/2020