ETHAN MYLES WHITAKER Physical Therapist License verification

Business Entity

NOT RENEWED

License Type

Physical Therapist

Description

LICENSED PHYSICAL THERAPIST ASSISTANT

License Number

160008531

License Status

NOT RENEWED

Business

First Name

ETHAN

Middle

MYLES

Last Name

WHITAKER

Business Name

ETHAN MYLES WHITAKER

Original Issue Date

03/26/2019

Effective Date

09/30/2019

Expiration Date

01/31/2022

City

KENOSHA

State

Zip

53142

Ever Disciplined

LastModifiedDate

05/19/2022