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General NPI Number Information
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NPI Number | 1720394760
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Entity Type | Individual
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Provider Name | WILLIAM OLIVER REESIDE III DPT
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Gender | Male
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 109 PARK PLACE CT
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City | LEXINGTON
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State | SC
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Zip | 29072-6690
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Country | US
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Telephone | 803-933-6784
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 BLANDING ST
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City | COLUMBIA
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State | SC
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Zip | 29201-3520
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Country | US
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Telephone | 803-256-4107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6268
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12762
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 6268
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License Number State | SC
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