Provider Demographics
NPI:1417139445
Name:SKINNER, GABRIEL SKINNER (LMT)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:SKINNER
Last Name:SKINNER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 27
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5506 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 27
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2600
Practice Address - Country:US
Practice Address - Phone:202-244-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMTO461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist