David Rodwell Walters II, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

052 Issued in SC

Practice address

112 Twelve Mile Dr
Lexington, SC 29072-3964

Phone

(803) 920-7634

NPI assigned

Oct 16, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1821630336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1922",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290711922",
            "telephone_number": "803-920-7634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 TWELVE MILE DR",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290723964",
            "telephone_number": "803-920-7634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "DAVID",
        "middle_name": "RODWELL",
        "name_suffix": "II",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-16",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "SC",
            "license": "052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "rod@rodwalters.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "112 Twelve Mile Dr",
            "city": "Lexington",
            "state": "SC",
            "country_code": "US",
            "postal_code": "290723964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Landon Wallace
• Lisa Anne Wallace, MA, LPC, NCC, CCNHC
• Kathleen Walter
• Angela K Walters, RPH
• Autumn Walters
• John R Walters, M.D.
• Ryan Alan Walters, MD
• Kayla Ward, PTA
• Alexis Ware
• Michelle Heath Warren, MCD, CCC-SLP

• Athletic Trainer in Lexington, SC
• Providers in Lexington, SC by specialty
• Athletic Trainer in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.