Individual
MR. LUKAS MICHEAL PASSALACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSAT, ATC
Contact information
Practice address
900 N JOHN R WOODEN DR, WEST LAFAYETTE, IN 47907
(765) 494-3245
(765) 494-9899
Mailing address
900 N JOHN R WOODEN DR, WEST LAFAYETTE, IN 47907-2117
(765) 494-3245
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
1631
AZ
2255A2300X
Athletic Trainer
Primary
36003098A
IN
Other
Enumeration date
04/26/2018
Last updated
11/26/2019
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