Provider Demographics
NPI:1326655598
Name:SALAZAR, GABRIELLE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 TRANQUILITY CT
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-3030
Mailing Address - Country:US
Mailing Address - Phone:304-261-2951
Mailing Address - Fax:
Practice Address - Street 1:205 HIRST RD STE 201
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6600
Practice Address - Country:US
Practice Address - Phone:681-252-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0018612255A2300X
VA01260041932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer