Individual
LUKAS DOMINIC MANIERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, OTC
Contact information
Practice address
1111 TRINITY LN STE 111, BLOOMINGTON, IL 61704-8112
(309) 663-6461
(309) 663-5711
Mailing address
1226 AIRPORT RD, BLOOMINGTON, IL 61704-2522
(847) 875-6849
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096004560
IL
246ZX2200X
Orthopedic Assistant
16-06-30
IL
Other
Enumeration date
12/29/2017
Last updated
12/29/2017
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