Organization · NPI-2

Aegis Group Practice LLC

Physical Therapist · Joplin, MO

NPI number1508639071
StatusActive
Last updated in NPPESNov 6, 2023

Details

NPI
1508639071
Entity type
Organization (NPI-2)
Legal business name
Aegis Group Practice LLC
Organization subpart
No
Enumeration date
Nov 6, 2023
Certification date
Nov 6, 2023
Last updated
Nov 6, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225100000X Physical Therapist––Yes
225X00000X Occupational Therapist––
235Z00000X Speech-Language Pathologist,––

Practice location

201 S Northpark Ln
Joplin, MO 64801-8426

Phone 479-201-6091

Mailing address

4933 Old Greenwood Rd
Fort Smith, AR 72903-6906

Authorized official

Tracy Mccall
Credentialing
4792016091

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