Healthcare Provider Details

I. General information

NPI: 1154915601
Provider Name (Legal Business Name): MIA TROIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 PROMENADE WALK
FORT MILL SC
29708-6992
US

IV. Provider business mailing address

200 E CAMA ST APT 289
CHARLOTTE NC
28217-1796
US

V. Phone/Fax

Practice location:
  • Phone: 803-547-1133
  • Fax: 803-543-1213
Mailing address:
  • Phone: 703-608-9947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12463
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23328
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: