Individual
MACKENZIE ANN LULLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AS, BAS, PTA
Contact information
Practice address
23525 W MILTON RD, WAUCONDA, IL 60084-2619
(847) 438-5400
Mailing address
1513 EVERGREEN ST, HOLIDAY HILLS, IL 60051-9128
(815) 861-0856
Taxonomy
Speciality
Code
Description
License number
State
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
160.009537
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003094996
PEDIATRICS IN MOTION
IL
Enumeration date
07/08/2022
Last updated
07/08/2022
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