Provider Demographics
NPI:1770873291
Name:CARLUCCI, GINA LYNNE (LMT)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:LYNNE
Last Name:CARLUCCI
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 1:4300 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1503
Mailing Address - Country:US
Mailing Address - Phone:703-933-9333
Mailing Address - Fax:703-820-0755
Practice Address - Street 1:4300 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1503
Practice Address - Country:US
Practice Address - Phone:703-933-9333
Practice Address - Fax:703-820-0755
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT1472225700000X
CA12315225700000X
MDM04369225700000X
VA0019008942225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist