KELLY L KUCKSDORF Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160003467

License Status

NOT RENEWED

Business

First Name

KELLY

Middle

Last Name

KUCKSDORF

Business Name

KELLY L KUCKSDORF

Original Issue Date

10/26/1999

Effective Date

10/26/1999

Expiration Date

09/30/2003

City

DEPERE

State

Zip

54115

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/17/2005