The holder whose full name is CAPUYAN, EDWIN REQUILLO,come from Fort Wayne IN,hold the Physical Therapist license(NO.05004058A) which status is Active.
| Name | CAPUYAN, EDWIN REQUILLO |
|---|---|
| License Number | 05004058A |
| License Type | Physical Therapist |
| License Status | Active |
| City | Fort Wayne |
| State | IN |