MEDICARE: GABRIEL JACK PAULSON 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
1	225100000X	Physical Therapist	P24575	NC

General Provider Information

NPI Number	:	1659239911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL JACK PAULSON DPT

Provider Business Mailing Address
First Line	:	401 N MAIN ST
Second Line	:
City	:	KENANSVILLE
State	:	NC
Zip	:	28349-8801
Country	:	US
Telephone Number	:	910-296-0941
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 SOUTH MAIN ST
Second Line	:
City	:	KENANSVILLE
State	:	NC
Zip	:	28349
Country	:	US
Telephone Number	:	910-372-9300
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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