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NPI Code Detail

MEDICARE: MIRIAM FANOUS PT, DPT

MEDICARE: MIRIAM FANOUS PT, 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
1261QP2000XPhysical Therapy Clinic/Center.13184SC

General Provider Information

NPI Number : 1972460236
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRIAM FANOUS PT, DPT
Provider Business Mailing Address
First Line : 22 FAIRVIEW RD
Second Line :
City : MAHOPAC
State : NY
Zip : 10541-3104
Country : US
Telephone Number : 845-200-5025
Fax Number :
Provider Business Practice Location Address
First Line : 4105 FABER PLACE DR STE 420
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-8594
Country : US
Telephone Number : 843-894-7374
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2026
Last Update Date : 01/08/2026

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