Provider Demographics
NPI:1417490319
Name:TOLBERT, AKILRA (LMT)
Entity Type:Individual
Prefix:
First Name:AKILRA
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 GRAND AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1735
Mailing Address - Country:US
Mailing Address - Phone:224-733-4239
Mailing Address - Fax:
Practice Address - Street 1:5400 GRAND AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1735
Practice Address - Country:US
Practice Address - Phone:224-733-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.017320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist