MEDICARE: TRAVIS J FAHEY 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	40QA01736900	NJ
2	225100000X	Physical Therapist	CP042247T	SC

General Provider Information

NPI Number	:	1710499041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS J FAHEY DPT

Provider Business Mailing Address
First Line	:	1559 SAM RITTENBERG BLVD STE A
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4248
Country	:	US
Telephone Number	:	973-493-7529
Fax Number	:

Provider Business Practice Location Address
First Line	:	1559 SAM RITTENBERG BLVD STE A
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4248
Country	:	US
Telephone Number	:	973-493-7529
Fax Number	:

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

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	03/16/2026

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Directions to “ TRAVIS J FAHEY DPT” Practice Location

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