License holder summary

JACK LANE IV is a Physical Therapy Licensure Board - Physical Therapist Assistant licensed to practice in Idaho. The address on file for JACK LANE IV is BOISE ID 83702. This licensed professional license is current. The license was granted 07/15/2014 and expired on 05/24/2017.

Idaho

Division of Occupational and Professional Licenses

JACK LANE IV
Physical Therapy Licensure Board - Physical Therapist Assistant
License number
PTA - 3672
Date granted
07/15/2014
Date expires
05/24/2017
Class
Physical Therapy Licensure Board - Physical Therapist Assistant
Status
Current
Address
BOISE ID 83702
idaholicensing.com
ID 43734339
LAST UPDATED 2024-02-22 11:15:18 UTC

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