Organization
AEGIS GROUP PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY S WILSON (CREDENTIALING SPECIALIST)
(972) 372-6779
Entity
Organization
Contact information
Practice address
8330 CASON RD, GLADSTONE, OR 97027-6401
(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
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
06/23/2023
Last updated
06/23/2023
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