Healthcare Provider Details

I. General information

NPI: 1417139445
Provider Name (Legal Business Name): GABRIEL SKINNER SKINNER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 CONNECTICUT AVE NW SUITE 27
WASHINGTON DC
20015-2600
US

IV. Provider business mailing address

5506 CONNECTICUT AVE NW SUITE 27
WASHINGTON DC
20015-2600
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-8222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMTO461
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: