Healthcare Provider Details

I. General information

NPI: 1356319222
Provider Name (Legal Business Name): JAMES R. WATTS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOORE ORTHOPAEDIC CLINIC, P.A. 14 MEDICAL PARK SUITE 200
COLUMBIA SC
29203
US

IV. Provider business mailing address

P.O. BOX 843446 HEALTHTOUCH, LLC
BOSTON MA
02284-3446
US

V. Phone/Fax

Practice location:
  • Phone: 803-227-8009
  • Fax: 803-227-8039
Mailing address:
  • Phone: 803-227-8009
  • Fax: 803-227-8039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4318
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: