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General NPI Number Information
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NPI Number | 1336498971
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Entity Type | Organization
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Legal Business Name | AEGIS THERAPIES
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 450 E 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2303
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Country | US
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Telephone | 402-727-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 450 E 23RD ST
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City | FREMONT
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State | NE
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Zip | 68025-2303
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Country | US
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Telephone | 402-727-3800
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. ASHLEY JEAN FORDYCE
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Credential | DPT
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Telephone | 408-727-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 3155
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License Number State | NE
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