MEDICARE: MRS. VANESSA MARIE GAULT D.P.T.

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
1	2251P0200X	Pediatric Physical Therapist	P12738	NC

General Provider Information

NPI Number	:	1467767400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA MARIE GAULT D.P.T.

Provider Business Mailing Address
First Line	:	6623 EXECUTIVE CIR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-8251
Country	:	US
Telephone Number	:	980-343-5450
Fax Number	:

Provider Business Practice Location Address
First Line	:	6623 EXECUTIVE CIR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-8251
Country	:	US
Telephone Number	:	980-343-5450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2010
Last Update Date	:	03/26/2026

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Directions to “ MRS. VANESSA MARIE GAULT D.P.T.” Practice Location

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