Healthcare Provider Details

I. General information

NPI: 1740095355
Provider Name (Legal Business Name): NOAH VINCENT PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8912 BLAKENEY PROFESSIONAL DR STE 100
CHARLOTTE NC
28277-6735
US

IV. Provider business mailing address

119 GERDING DR
WINGATE NC
28174-9601
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-5353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23850
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: