SHELLEY D BERGEN Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070004988

License Status

NOT RENEWED

Business

First Name

SHELLEY D

Last Name

BERGEN

Business Name

SHELLEY D BERGEN

Original Issue Date

01/10/1987

Effective Date

01/10/1987

Expiration Date

09/30/1990

City

LACROSSE

State

Zip

54601

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/14/2005