Aegis Group Practice LLC
Physical Therapist in Faribault, MN. Organization (NPI-2).
NPI number1992423974
StatusActive
Last updated in NPPESAug 16, 2022
Details
- NPI
- 1992423974
- Entity type
- Organization (NPI-2)
- Legal business name
- Aegis Group Practice LLC
- Organization subpart
- No
- Enumeration date
- Aug 16, 2022
- Certification date
- Aug 16, 2022
- Last updated
- Aug 16, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | – | – | Yes |
| 225X00000X | Occupational Therapist | – | – | |
| 235Z00000X | Speech-Language Pathologist, | – | – |
Practice location
1520 17th St NwFaribault, MN 55021-2817
Phone 800-444-6845 · Fax 479-478-2852
Mailing address
2601 Network Blvd Ste 102Frisco, TX 75034-9092
Phone 972-372-6779 · Fax 479-668-0872
Authorized official
Misty S Wilson
Contract/Credentialing Specialist
9723726779
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