Healthcare Provider Details

I. General information

NPI: 1114386117
Provider Name (Legal Business Name): WIGS PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 CONNECTICUT AVE NW STE 3A
WASHINGTON DC
20009-1220
US

IV. Provider business mailing address

3509 CONNECTICUT AVE NW STE 191
WASHINGTON DC
20008-2400
US

V. Phone/Fax

Practice location:
  • Phone: 202-803-2752
  • Fax:
Mailing address:
  • Phone: 202-549-4111
  • Fax: 202-478-5130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. LESLIE LELAND
Title or Position: MANAGER
Credential:
Phone: 202-549-4111