Healthcare Provider Details

I. General information

NPI: 1962178467
Provider Name (Legal Business Name): R.P. WIGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W COLONIAL DR STE 11
ORLANDO FL
32804-6948
US

IV. Provider business mailing address

2668 ROBERT TRENT JONES DR APT 435
ORLANDO FL
32835-6273
US

V. Phone/Fax

Practice location:
  • Phone: 321-297-2656
  • Fax:
Mailing address:
  • Phone: 321-297-2656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: RONICE PERRY
Title or Position: OWNER
Credential:
Phone: 321-297-2656