The holder whose full name is Wallen, Shane M.,come from Warsaw IN,hold the Phys Ther Assistant license(NO.06004508A) which status is Active.
| Name | Wallen, Shane M. |
|---|---|
| License Number | 06004508A |
| License Type | Phys Ther Assistant |
| License Status | Active |
| City | Warsaw |
| State | IN |