JENNY DARICE CAPOUCH Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160004638

License Status

NOT RENEWED

Business

First Name

JENNY

Middle

DARICE

Last Name

CAPOUCH

Business Name

JENNY DARICE CAPOUCH

Original Issue Date

09/12/2006

Effective Date

09/29/2009

Expiration Date

09/30/2011

City

COTTAGE GROVE

State

Zip

53527

County

WISCONSIN

Ever Disciplined

LastModifiedDate

11/04/2011