Provider Demographics
NPI:1720751613
Name:WATERS, WILLIAM PRENTIS III (DPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PRENTIS
Last Name:WATERS
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 1:1702 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1549
Mailing Address - Country:US
Mailing Address - Phone:864-590-8769
Mailing Address - Fax:
Practice Address - Street 1:3561 DREHER SHOALS RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9115
Practice Address - Country:US
Practice Address - Phone:803-234-4138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100462251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic