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General NPI Number Information
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NPI Number | 1538858857
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 5000 W CHAMPION DR
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City | GRAND CHUTE
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State | WI
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Zip | 54913-5000
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Country | US
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Telephone | 920-560-1123
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Fax | 920-202-3535
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Provider Business Mailing Address
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Address Line | 2105 E ENTERPRISE AVE STE 113
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City | APPLETON
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State | WI
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Zip | 54913-7862
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Country | US
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Telephone | 920-991-2561
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Fax | 920-991-2563
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | CAMILLA MEYER
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Credential |
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Telephone | 920-393-2819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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