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General NPI Number Information
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NPI Number | 1770873291
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Entity Type | Individual
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Provider Name | GINA LYNNE CARLUCCI LMT
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Gender | Female
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 4300 KING ST
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City | ALEXANDRIA
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State | VA
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Zip | 22302-1503
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Country | US
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Telephone | 703-933-9333
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Fax | 703-820-0755
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Provider Business Mailing Address
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Address Line | 4300 KING ST
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City | ALEXANDRIA
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State | VA
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Zip | 22302-1503
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Country | US
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Telephone | 703-933-9333
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Fax | 703-820-0755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT1472
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 12315
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M04369
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019008942
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License Number State | VA
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