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NPI Code Detail

MEDICARE: GABRIELLE NICOLE AXSON DPT

MEDICARE: GABRIELLE NICOLE AXSON DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical TherapistSC

General Provider Information

NPI Number : 1407796493
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE NICOLE AXSON DPT
Provider Business Mailing Address
First Line : 2387 LANTERN ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-4850
Country : US
Telephone Number : 317-750-9879
Fax Number : 843-620-0722
Provider Business Practice Location Address
First Line : 2387 LANTERN ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-4850
Country : US
Telephone Number : 317-750-9879
Fax Number : 843-620-0722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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