Provider Demographics
NPI:1376943027
Name:MACKLIN, TUNISIA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TUNISIA
Middle Name:
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:TUNISIA
Other - Middle Name:
Other - Last Name:MACKLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:201 E ARMY TRAIL RD STE 307
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2138
Mailing Address - Country:US
Mailing Address - Phone:630-635-2189
Mailing Address - Fax:
Practice Address - Street 1:201 E ARMY TRAIL RD STE 307
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2138
Practice Address - Country:US
Practice Address - Phone:630-635-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-31
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
IL227008685172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula
No172M00000XOther Service ProvidersMechanotherapist