NPI 1164939179

Lukas Dominic Manieri, ATCOTC

Practitioner Athletic Trainer Bloomington, IL

Practice location

Address: 1111 Trinity Ln STE 111, Bloomington, IL 61704-8112
Phone: (309) 663-6461
Fax: (309) 663-5711
Mailing address: 1226 Airport Rd, Bloomington, IL 61704-2522

Registered specialties (2)

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 096004560 (IL)

Other Specialist/Technologist providers in Illinois →

Orthopedic Assistant

Technologists, Technicians & Other Technical Service Providers Taxonomy 246ZX2200X Licence 16-06-30 (IL)

Other Specialist/Technologist, Other providers in Illinois →

Registry record

NPI: 1164939179
Entity type: Individual
Sex (as registered): Male
NPI issued: 29 Dec 2017
Record last updated: 29 Dec 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.