Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mackenzie Ann Lullo, AS, BAS, PTA

Individual provider Pediatric Rehabilitation Medicine Physician · NPI 1063145712

Mackenzie Ann Lullo, AS, BAS, PTA is a Pediatric Rehabilitation Medicine Physician in Wauconda, Illinois. Licensed in Illinois. Registered with an NPI since 2022.

Licensed in
IL
In the registry since
2022
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

See every abbreviation used in this directory →

Practice location Address checks out

23525 W Milton Rd
Wauconda, IL 60084-2619
Phone: (847) 438-5400
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Rehabilitation Medicine Physician (primary) Taxonomy 2081P0010X · Licence 160.009537 (IL)

Record details

NPI number1063145712
Entity typeIndividual (Type 1)
GenderFemale
Credentials AS , BAS , PTA
Sole proprietorNo
NPI enumeratedJuly 8, 2022
Last updated in NPPESJuly 8, 2022
Certification dateJuly 8, 2022