# AEGIS GROUP PRACTICE LLC

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

## Provider details

- **NPI number:** 1881311421
- **Authorized official:** MISTY S WILSON (CONTRACT/CREDENTIALING REP)
- **Authorized official phone:** (972) 372-6779

## Contact information

- **Practice address:** 4400 LANGE AVE NE, SAINT MICHAEL, MN 55376-9556
- **Practice address phone:** (763) 777-9445
- **Practice address fax:** (479) 401-2173
- **Mailing address:** 2601 NETWORK BLVD STE 102, FRISCO, TX 75034-9092
- **Mailing address phone:** (972) 372-6779
- **Mailing address fax:** (479) 668-0872

## 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:** 10/25/2022
- **Last updated:** 06/17/2026