Healthcare Provider Details

I. General information

NPI: 1184403081
Provider Name (Legal Business Name): AEGIS THERAPIES - FLORIDA REHAB AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CYPRESS WAY E
NAPLES FL
34110-1244
US

IV. Provider business mailing address

4933 OLD GREENWOOD RD
FORT SMITH AR
72903-6906
US

V. Phone/Fax

Practice location:
  • Phone: 239-299-6996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TRACY MCCALL
Title or Position: CREDENTIALING
Credential:
Phone: 479-201-6091