The holder whose full name is Wayne, Jared Russell,come from Valparaiso IN,hold the Physical Therapist license(NO.05011203A) which status is Active.
| Name | Wayne, Jared Russell |
|---|---|
| License Number | 05011203A |
| License Type | Physical Therapist |
| License Status | Active |
| City | Valparaiso |
| State | IN |