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General NPI Number Information
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NPI Number | 1912701830
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Entity Type | Organization
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Legal Business Name | WILSON SHULTERBRANDT HOLDINGS, LLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 13569 PANAMA CITY BEACH PKWY
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-2847
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Country | US
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Telephone | 850-238-8563
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Fax | 850-238-8564
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Provider Business Mailing Address
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Address Line | 3316 CHARLES CT
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City | CHALMETTE
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State | LA
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Zip | 70043-2615
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Country | US
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Telephone | 985-517-4561
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ANGEL SHULTERBRANDT
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Credential |
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Telephone | 985-517-4561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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