Provider Demographics
NPI:1720394760
Name:REESIDE, WILLIAM OLIVER III (DPT)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:OLIVER
Last Name:REESIDE
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 BLANDING ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3520
Mailing Address - Country:US
Mailing Address - Phone:803-256-4107
Mailing Address - Fax:
Practice Address - Street 1:109 PARK PLACE CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6690
Practice Address - Country:US
Practice Address - Phone:803-933-6784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6268225100000X, 2251X0800X
NC12762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12762OtherNC BOARD OF PT EXAMINERS
SC6268OtherSC BOARD OF PT EXAMINERS
NC12762OtherNC BOARD OF PT EXAMINERS