Lukas Dominic Manieri, ATC, OTC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096004560 Issued in IL

Practice address

1111 Trinity LN Ste 111
Bloomington, IL 61704-8112

Phone

(309) 663-6461

Fax

(309) 663-5711

NPI assigned

Dec 29, 2017

Last updated

Dec 29, 2017By the provider in NPPES

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": "1514505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514505600000",
    "number": "1164939179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1226 AIRPORT RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617042522",
            "telephone_number": "847-875-6849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 TRINITY LN STE 111",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617048112",
            "telephone_number": "309-663-6461",
            "fax_number": "309-663-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANIERI",
        "first_name": "LUKAS",
        "middle_name": "DOMINIC",
        "credential": "ATC, OTC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-29",
        "last_updated": "2017-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096004560",
            "primary": true
        },
        {
            "code": "246ZX2200X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Orthopedic Assistant",
            "state": "IL",
            "license": "16-06-30",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paula Delores Malone, CST/RST, SA
• Amy Mammadov, MS, CCC-SLP
• Andy Mancini, DMD, MBA
• Matthew Mangold, DC
• Harirajan Mani, MD
• Trisha Dyan Mann, PHD
• Courtney Manning, DPT
• Kristin Elizabeth Manzi, LCSW
• Maple Shade Dental Bloomington LLC
• Marathon Health, LLC (Marathon Health, Bloomington IL- E Empire St)

• Athletic Trainer in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2017; 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.