Aegis Group Practice LLC
Organization Active NPI Physical Therapist · Goodyear, AZ
NPI 1235845504 · NPPES record last updated Jan 30, 2023
Key facts
- NPI
- 1235845504
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 14930 W Wigwam Blvd
Goodyear, AZ 85395-7661 - Phone
- (800) 444-6845
- Fax
- (479) 478-2852
- NPI assigned
- Jan 30, 2023
- Organization subpart
- No
Authorized official
- Name
- Misty S Wilson
- Title
- Contract & Credentialing Specialist
- Phone
- (972) 372-6779
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 6
Practitioners 4
-
Emily J Koshevatskiy, DPT
-
Lacey E Ramos, M.S., CCC-SLP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221228000651 | AZ | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 9 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Goodyear, AZ; Green Valley, AZ; Mesa, AZ; Oro Valley, AZ; Sierra Vista, AZ; Tucson, AZ |
National Provider Directory
- Tax ID family
- Aegis Group Practice
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X |
Addresses
Primary practice location
14930 W Wigwam Blvd
Goodyear, AZ 85395-7661
Mailing address
2601 Network Blvd Ste 102
Frisco, TX 75034-9092
Phone (972) 372-6779
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All providers in Goodyear, AZ · Physical Therapist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.