Organization · NPI-2

Aegis Group Practice, LLC

Occupational Therapist · Hollywood, FL

NPI number1740720002

StatusActive

Last updated in NPPESMar 6, 2017

Details

NPI: 1740720002
Entity type: Organization (NPI-2)
Legal business name: Aegis Group Practice, LLC
Organization subpart: Yes
Enumeration date: Mar 6, 2017
Last updated: Mar 6, 2017

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
225X00000X	Occupational Therapist	–	–	Yes
225100000X	Physical Therapist	–	–
235Z00000X	Speech-Language Pathologist,	–	–

Practice location

2580 Pine Island Rd
Hollywood, FL 33024-8582

Phone 479-201-2000 · Fax 479-201-4801

Mailing address

1000 Fianna Way # Md4843
Fort Smith, AR 72919-9008

Phone 479-201-2000 · Fax 479-201-4801

Authorized official

Mike Mcolvin
Director
4792012000

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