=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568319473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCULPT WELLNESS AND WEIGHT LOSS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2026
-----------------------------------------------------
Last Update Date | 03/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5115 BERNARD DR STE 106
-----------------------------------------------------
City | CAVE SPRING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-4367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-200-8336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5115 BERNARD DR STE 106
-----------------------------------------------------
City | CAVE SPRING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-4367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-200-8336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DIANA WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-369-0554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------