Provider Demographics
NPI:1154915601
Name:TROIANO, MIA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:TROIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E CAMA ST APT 289
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1796
Mailing Address - Country:US
Mailing Address - Phone:703-608-9947
Mailing Address - Fax:
Practice Address - Street 1:857 PROMENADE WALK
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6992
Practice Address - Country:US
Practice Address - Phone:803-547-1133
Practice Address - Fax:803-543-1213
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 225100000X
SC12463225100000X
NC23328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer