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Organization
AEGIS GROUP PRACTICE LLC
Active
Organization
AEGIS GROUP PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY S WILSON (CONTRACT & CREDENTIALING SPECIALIST)
(972) 372-6779
Entity
Organization
Contact information
Practice address
1551 E CHEVY CHASE DR, GLENDALE, CA 91206-4138
(800) 444-6845
(479) 478-2852
Mailing address
2601 NETWORK BLVD STE 102, FRISCO, TX 75034-9092
(972) 372-6779
(479) 668-0872
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
02/27/2023
Last updated
02/27/2023
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