Healthcare Provider Details

I. General information

NPI: 1306559778
Provider Name (Legal Business Name): GABRIEL S LUCIANI PT, DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 FAIRFAX DR STE 300
ARLINGTON VA
22203-1613
US

IV. Provider business mailing address

5866 POST CORNERS TRL APT G
CENTREVILLE VA
20120-6332
US

V. Phone/Fax

Practice location:
  • Phone: 703-292-4060
  • Fax: 703-292-4066
Mailing address:
  • Phone: 603-313-7706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0001575
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126003882
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT23000124
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305215374
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: