Aegis Group Practice LLC
Organization Active NPI Physical Therapist · Port Washington, WI
NPI 1366900136 · NPPES record last updated Sep 15, 2022
Key facts
- NPI
- 1366900136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 1330 W Lincoln Ave
Port Washington, WI 53074-2050 - Phone
- (800) 444-6845
- NPI assigned
- Mar 11, 2019
- Organization subpart
- No
Authorized official
- Name
- Misty S Wilson
- Title
- Contract/Credentialing Specialist
- Phone
- (972) 372-6779
Other NPIs on the same Medicare enrollment 27
Corporate family (same tax ID) 22
Practitioners 2
-
Nelly Marie Paul, OT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170614002978 | WI | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 61 practitioners 27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wisconsin Rapids, WI; West Bend, WI; West Allis, WI; Port Washington, WI; Plymouth, WI; Oshkosh, WI; Hartland, WI; Onalaska, WI… |
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
1330 W Lincoln Ave
Port Washington, WI 53074-2050
Mailing address
2601 Network Blvd Ste 102
Frisco, TX 75034-9092
Phone (972) 372-6779
Other providers in Port Washington, WI
- Advanced Healthcare, S.C.
- Advanced Healthcare, S.C.
- Advanced Healthcare, S.C.
- Align Chiropractic of Port, S.C.
- Dylan Michael Allen
- Beth Ann Anderson
- Dennis J Anderson
- Barbara Arcuri
All providers in Port Washington, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2022. 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.