# MACKENZIE ANN LULLO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1063145712
- **Gender:** F
- **Credential:** AS, BAS, PTA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | 160.009537 | IL | Yes |

## Other

- **Enumeration date:** 07/08/2022
- **Last updated:** 07/08/2022