Aegis Group Practice LLC
Organization Active NPI Physical Therapist · Rogers, MN
NPI 1942017793 · NPPES record last updated Dec 16, 2024
Key facts
- NPI
- 1942017793
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 21900 S Diamond Lake Rd
Rogers, MN 55374-4640 - Phone
- (479) 201-6091
- NPI assigned
- Dec 16, 2024
- Organization subpart
- No
Authorized official
- Name
- Tracy McCall
- Title
- Credentialing
- Phone
- (479) 201-6091
Other NPIs on the same Medicare enrollment 33
Corporate family (same tax ID) 15
Practitioners 1
-
Laura Berry, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150612001586 | MN | Part B Supplier - Clinic/Group Practice | 5193036432 |
Receives reassigned benefits from 71 practitioners 33 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rogers, MN; Zimmerman, MN; Willmar, MN; White Bear Lake, MN; Shakopee, MN; Savage, MN; Sartell, MN; Saint Michael, MN… |
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
21900 S Diamond Lake Rd
Rogers, MN 55374-4640
Mailing address
4933 Old Greenwood Rd
Fort Smith, AR 72903-6906
Phone (479) 201-6091
Other providers in Rogers, MN
- 1And2 Home Health LLC
- A Better Living Care Services, LLC
- A Gentle Dental Center of Rogers
- Adoptive Steps Therapy Inc
- Affinity Living Assistance Co
- Rebecca Ann Ahlstrom
- Shamsa Ahmed
- Daniel A Albright
- Diane Menzies Alderman
All providers in Rogers, MN · Physical Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 16, 2024. 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.