| Doctor Name: | ALLISON MACTAVISH |
| NPI Number: | 1831565803 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 070021517 |
| Business Practice Address: | 22285 N Pepper Rd #301 Lake Barrington, IL - 600102538 |
| Business Phone Number: | 8478420597 |
| Business Fax Number: | |
| Mailing Address: | 22285 N Pepper Rd, #301 LAKE BARRINGTON |
| State: | IL |
| Postal Code: | 600102538 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/13/2015 |
| NPI Last Update Date: | 08/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | 070021517 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |