Provider Demographics
NPI:1356197123
Name:LUCIANO, GABRIELLE (LMT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:LUCIANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 MARKET ST APT 2034
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-6522
Mailing Address - Country:US
Mailing Address - Phone:530-919-8269
Mailing Address - Fax:
Practice Address - Street 1:329 S MONTEZUMA ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4221
Practice Address - Country:US
Practice Address - Phone:530-919-8269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-29399225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist