Active NPI
William Prentis Waters III, DPT
- Orthopedic Physical Therapist
- Irmo, SC
National Provider Identifier
1720751613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 10046
- Practice address
- 3561 Dreher Shoals Rd
Irmo, SC 29063-9115 - Phone
- (803) 234-4138
- NPI assigned
- Jul 27, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 10046 | SC | Primary |
Addresses
Primary practice location
3561 Dreher Shoals Rd
Irmo, SC 29063-9115
Mailing address
1702 Beaver Dam Rd
Columbia, SC 29212-1549
Phone (864) 590-8769
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10046 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627344000000",
"number": "1720751613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1702 BEAVER DAM RD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292121549",
"telephone_number": "864-590-8769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3561 DREHER SHOALS RD",
"city": "IRMO",
"state": "SC",
"postal_code": "290639115",
"telephone_number": "803-234-4138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "WILLIAM",
"middle_name": "PRENTIS",
"name_suffix": "III",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-27",
"last_updated": "2021-07-27",
"certification_date": "2021-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "SC",
"license": "10046",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irmo, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.