Organization · NPI-2
Aegis Group Practice LLC
Physical Therapist · Greenville, SC
NPI number1063230704
StatusActive
Last updated in NPPESOct 1, 2024
Details
- NPI
- 1063230704
- Entity type
- Organization (NPI-2)
- Legal business name
- Aegis Group Practice LLC
- Organization subpart
- No
- Enumeration date
- Oct 1, 2024
- Certification date
- Oct 1, 2024
- Last updated
- Oct 1, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | – | – | Yes |
| 225X00000X | Occupational Therapist | – | – | |
| 235Z00000X | Speech-Language Pathologist, | – | – |
Practice location
12 Boyce AveGreenville, SC 29601-3149
Phone 479-201-6091
Mailing address
4933 Old Greenwood RdFort Smith, AR 72903-6906
Authorized official
Tracy Mccall
Credentialing
4792016091
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