Provider Demographics
NPI:1770912032
Name:VAN SICKLE, GABRIELA ACIERNO
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ACIERNO
Last Name:VAN SICKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:CHRISTINE
Other - Last Name:ACIERNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 BUCKINGHAM STATION DR APT 3C
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 BUCKINGHAM STATION DR
Practice Address - Street 2:APT 3I
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4636
Practice Address - Country:US
Practice Address - Phone:804-560-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305208396OtherVA STATE PHYSICAL THERAPY LICENSE