Provider Demographics
NPI:1821636754
Name:RBS WIG STUDIO BOUTIQUE & SPA LLC
Entity Type:Organization
Organization Name:RBS WIG STUDIO BOUTIQUE & SPA LLC
Other - Org Name:RBS WIG STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-282-1479
Mailing Address - Street 1:12472 LAKE UNDERHILL RD STE 163
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7144
Mailing Address - Country:US
Mailing Address - Phone:321-282-1479
Mailing Address - Fax:
Practice Address - Street 1:4401 E COLONIAL DR STE 105B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5200
Practice Address - Country:US
Practice Address - Phone:321-282-1479
Practice Address - Fax:833-276-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier