Healthcare Provider Details

I. General information

NPI: 1720451453
Provider Name (Legal Business Name): AEGIS THERAPIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WAVELAND AVE
WINCHESTER KY
40391-1231
US

IV. Provider business mailing address

4933 OLD GREENWOOD RD
FORT SMITH AR
72903-6906
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-8375
  • Fax:
Mailing address:
  • Phone: 877-823-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOLLY RASMUSSEN-JONES
Title or Position: SECRETARY
Credential:
Phone: 479-201-4835