Lukas Micheal Passalacqua, MSAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36003098A Issued in IN

Practice address

900 N John R Wooden Dr
West Lafayette, IN 47907

Phone

(765) 494-3245

Fax

(765) 494-9899

NPI assigned

Apr 26, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1104314046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N JOHN R WOODEN DR",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479072117",
            "telephone_number": "765-494-3245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N JOHN R WOODEN DR",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "47907",
            "telephone_number": "765-494-3245",
            "fax_number": "765-494-9899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 N John R Wooden Dr",
            "address_purpose": "LOCATION",
            "city": "West Lafayette",
            "state": "IN",
            "postal_code": "47907",
            "country_code": "US",
            "telephone_number": "765-494-3245",
            "fax_number": "765-494-9899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASSALACQUA",
        "first_name": "LUKAS",
        "middle_name": "MICHEAL",
        "name_prefix": "Mr.",
        "credential": "MSAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-26",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "1631",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36003098A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Paquette
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• Mackenzie Partain
• Partners in Hope Indiana LLC
• Justin Partyka
• Bhaumik J Patel
• Kishan B Patel, MD
• Meenal Chirag Patel, NP
• Benjamin W Patrick
• Abbey Lynn Patterson

• Athletic Trainer in West Lafayette, IN
• Providers in West Lafayette, IN by specialty
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.