# AEGIS GROUP PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063230704
- **Authorized official:** TRACY MCCALL (CREDENTIALING)
- **Authorized official phone:** (479) 201-6091

## Contact information

- **Practice address:** 12 BOYCE AVE, GREENVILLE, SC 29601-3149
- **Practice address phone:** (479) 201-6091
- **Mailing address:** 4933 OLD GREENWOOD RD, FORT SMITH, AR 72903-6906

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 10/01/2024
- **Last updated:** 10/01/2024