Provider Demographics
NPI:1194479717
Name:DEVRIES, WILLIAM HENDRIK (DPT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENDRIK
Last Name:DEVRIES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 OLD GEORGETOWN RD STE C
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7307
Mailing Address - Country:US
Mailing Address - Phone:843-936-3385
Mailing Address - Fax:843-388-4868
Practice Address - Street 1:1341 OLD GEORGETOWN RD STE C
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7307
Practice Address - Country:US
Practice Address - Phone:843-936-3385
Practice Address - Fax:843-388-4868
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC111072081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine