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General NPI Number Information
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NPI Number | 1033093695
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Entity Type | Organization
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Legal Business Name | AEGIS GROUP PRACTICE LLC
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 960 19TH ST S
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City | SARTELL
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State | MN
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Zip | 56377-2597
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Country | US
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Telephone | 479-201-6091
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Fax |
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Provider Business Mailing Address
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Address Line | 4933 OLD GREENWOOD RD
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City | FORT SMITH
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State | AR
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Zip | 72903-6906
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Country | US
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Telephone | 479-201-6091
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | TERRY LAMB
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Credential |
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Telephone | 479-201-6037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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