Organization
AEGIS GROUP PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY MCCALL (CREDENTIALING)
(479) 201-6091
Entity
Organization
Contact information
Practice address
1200 OVERLOOK DR, LAKE OSWEGO, OR 97034-6605
(479) 201-6091
Mailing address
4933 OLD GREENWOOD RD, FORT SMITH, AR 72903-6906
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
02/08/2024
Last updated
02/08/2024
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