Provider Demographics
NPI:1437330339
Name:AEGIS PHYSICAL THERAPY INC. PS
Entity Type:Organization
Organization Name:AEGIS PHYSICAL THERAPY INC. PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:MERLIN
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:509-895-7449
Mailing Address - Street 1:PO BOX 2721
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2721
Mailing Address - Country:US
Mailing Address - Phone:509-895-7449
Mailing Address - Fax:509-895-7452
Practice Address - Street 1:3901 KERN WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7804
Practice Address - Country:US
Practice Address - Phone:509-895-7449
Practice Address - Fax:509-895-7452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010836261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6177520001Medicare NSC