Healthcare Provider Details

I. General information

NPI: 1821636754
Provider Name (Legal Business Name): RBS WIG STUDIO BOUTIQUE & SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 E COLONIAL DR STE 105B
ORLANDO FL
32803-5200
US

IV. Provider business mailing address

12472 LAKE UNDERHILL RD STE 163
ORLANDO FL
32828-7144
US

V. Phone/Fax

Practice location:
  • Phone: 321-282-1479
  • Fax: 833-276-2220
Mailing address:
  • Phone: 321-282-1479
  • Fax:

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: SHANTAN AKPAN
Title or Position: PRESIDENT
Credential:
Phone: 321-282-1479