Individual
MIRIAM FANOUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
4105 FABER PLACE DR STE 420, NORTH CHARLESTON, SC 29405-8594
(843) 894-7374
Mailing address
22 FAIRVIEW RD, MAHOPAC, NY 10541-3104
(845) 200-5025
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
.13184
SC
225100000X
Physical Therapist
055348
NY
261QP2000X
Physical Therapy Clinic/Center
Primary
.13184
SC
Other
Enumeration date
01/08/2026
Last updated
02/17/2026
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