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General NPI Number Information
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NPI Number | 1821460866
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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 | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | N892 CLUB CIRCLE DR
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City | PRAIRIE DU SAC
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State | WI
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Zip | 53578-9545
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Country | US
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Telephone | 608-235-8364
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Fax |
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Provider Business Mailing Address
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Address Line | N892 CLUB CIRCLE DR
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City | PRAIRIE DU SAC
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State | WI
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Zip | 53578-9545
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | LAUREN BALLWEG
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Credential |
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Telephone | 608-235-8364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2381
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License Number State | WI
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