Provider Demographics
NPI:1306559778
Name:LUCIANI, GABRIEL S (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:S
Last Name:LUCIANI
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5866 POST CORNERS TRL APT G
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6332
Mailing Address - Country:US
Mailing Address - Phone:603-313-7706
Mailing Address - Fax:
Practice Address - Street 1:4040 FAIRFAX DR STE 300
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1613
Practice Address - Country:US
Practice Address - Phone:703-292-4060
Practice Address - Fax:703-292-4066
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00015752255A2300X
VA01260038822255A2300X
DCAT230001242255A2300X
VA2305215374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer