The holder whose full name is Shively, Amanda M,come from Fort Wayne IN,hold the Phys Ther Assistant license(NO.06003103A) which status is Active.
| Name | Shively, Amanda M |
|---|---|
| License Number | 06003103A |
| License Type | Phys Ther Assistant |
| License Status | Active |
| City | Fort Wayne |
| State | IN |