The holder whose full name is SUPENA, R PHINNE FULE,come from LAKEWOOD NJ,hold the Physical Therapist license(NO.05005403A) which status is Expired.
| Name | SUPENA, R PHINNE FULE |
|---|---|
| License Number | 05005403A |
| License Type | Physical Therapist |
| License Status | Expired |
| City | LAKEWOOD |
| State | NJ |