The holder whose full name is NIEVES, MADELINE,come from SOUTH BEND IN,hold the Physical Therapist license(NO.05002400A) which status is Expired.
| Name | NIEVES, MADELINE |
|---|---|
| License Number | 05002400A |
| License Type | Physical Therapist |
| License Status | Expired |
| City | SOUTH BEND |
| State | IN |