Healthcare Provider Details

I. General information

NPI: 1659186286
Provider Name (Legal Business Name): JOHN NEELY GILBERT IV PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 GATEWAY BLVD.
MOORESVILLE NC
28117-5540
US

IV. Provider business mailing address

114 WELTON WAY STE B
MOORESVILLE NC
28117-9251
US

V. Phone/Fax

Practice location:
  • Phone: 704-658-1095
  • Fax: 704-658-1097
Mailing address:
  • Phone: 704-660-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23840
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: