The holder whose full name is Requena, Emmanuel,come from Fort Wayne IN,hold the Phys Ther Assistant license(NO.06004053A) which status is Active.
| Name | Requena, Emmanuel |
|---|---|
| License Number | 06004053A |
| License Type | Phys Ther Assistant |
| License Status | Active |
| City | Fort Wayne |
| State | IN |