Provider Demographics
NPI:1154738482
Name:SOLUM, LUCAS (MS, LAT, CSCS)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:
Last Name:SOLUM
Suffix:
Gender:M
Credentials:MS, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-3413
Mailing Address - Country:US
Mailing Address - Phone:414-378-4721
Mailing Address - Fax:
Practice Address - Street 1:2335 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-3413
Practice Address - Country:US
Practice Address - Phone:414-378-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI898-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer