Healthcare Provider Details

I. General information

NPI: 1134090301
Provider Name (Legal Business Name): ALEAH WATERS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 CHARTER OAK RD
LEXINGTON SC
29072-9246
US

IV. Provider business mailing address

112 DEERGLADE CT
LEXINGTON SC
29072-8048
US

V. Phone/Fax

Practice location:
  • Phone: 803-359-1551
  • Fax:
Mailing address:
  • Phone: 803-359-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6787
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: