KELLY C FAGUNDES Physical Therapist License verification

Business Entity

INACTIVE

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST

License Number

070013927

License Status

INACTIVE

Business

First Name

KELLY

Middle

Last Name

FAGUNDES

Business Name

KELLY C FAGUNDES

Original Issue Date

05/24/2004

Effective Date

07/10/2008

Expiration Date

09/30/2010

City

EGG HARBOR

State

Zip

54209

County

WISCONSIN

Ever Disciplined

LastModifiedDate

07/08/2010