Aegis Group Practice LLC
Organization Active NPI Physical Therapist · Faribault, MN
NPI 1992423974 · NPPES record last updated Aug 16, 2022
Key facts
- NPI
- 1992423974
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- AEGIS GROUP PRACTICE LLC
- Practice address
- 1520 17TH St NW
Faribault, MN 55021-2817 - Phone
- (800) 444-6845
- Fax
- (479) 478-2852
- NPI assigned
- Aug 16, 2022
- Organization subpart
- No
Authorized official
- Name
- Misty S Wilson
- Title
- Contract/Credentialing Specialist
- Phone
- (972) 372-6779
Other NPIs on the same Medicare enrollment 33
Corporate family (same tax ID) 12
Member of 1
Practitioners 1
-
Kelly Kitzman, PT
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
1520 17TH St NW
Faribault, MN 55021-2817
Mailing address
2601 Network Blvd Ste 102
Frisco, TX 75034-9092
Phone (972) 372-6779
Other providers in Faribault, MN
- Ruweyda Aden
- Yussuf Aden
- Erik Michael Adolphson
- Advanced Foot & Ankle Clinic LLC
- Advanced Hearing Inc
- Kelsey Ahlers
- Matthew Ahlskog
- Faduma Ahmed
- Ibrahim Ahmed
- Khadijo Ahmed
All providers in Faribault, 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 Aug 16, 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.