LISA MARIE VANDER BLOOMER Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070012506

License Status

NOT RENEWED

Business

First Name

LISA

Middle

MARIE

Last Name

VANDER BLOOMER

Business Name

LISA MARIE VANDER BLOOMER

Original Issue Date

06/06/2001

Effective Date

06/06/2001

Expiration Date

09/30/2002

City

GREEN BAY

State

Zip

54303

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/17/2005