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General NPI Number Information
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NPI Number | 1639661119
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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 | 05/31/2018
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 1931 MARINETTE AVE
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City | MARINETTE
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State | WI
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Zip | 54143-3801
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Country | US
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Telephone | 715-735-5500
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Fax | 715-735-5502
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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 | 920-560-1083
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Fax | 920-560-1098
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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 | 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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Taxonomy #2
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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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