Organization · NPI-2

Aegis Group Practice LLC

Physical Therapist · Melbourne, FL

NPI number1649090218
StatusActive
Last updated in NPPESOct 16, 2024

Details

NPI
1649090218
Entity type
Organization (NPI-2)
Legal business name
Aegis Group Practice LLC
Organization subpart
No
Enumeration date
Oct 16, 2024
Certification date
Oct 16, 2024
Last updated
Oct 16, 2024

Taxonomy and licenses

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

Practice location

4881 Dairy Rd
Melbourne, FL 32904-1800

Phone 479-201-6091

Mailing address

4933 Old Greenwood Rd
Fort Smith, AR 72903-6906

Phone 479-201-6091

Authorized official

Tracy Mccall
Credentialing
4792016091

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