MEDICARE: ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1538858857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC

Provider Business Mailing Address
First Line	:	2105 E ENTERPRISE AVE STE 113
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-7862
Country	:	US
Telephone Number	:	920-991-2561
Fax Number	:	920-991-2563

Provider Business Practice Location Address
First Line	:	5000 W CHAMPION DR
Second Line	:
City	:	GRAND CHUTE
State	:	WI
Zip	:	54913-5000
Country	:	US
Telephone Number	:	920-560-1123
Fax Number	:	920-202-3535

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	CAMILLA MEYER
Credential	:
Telephone Number	:	920-393-2819

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	12/18/2025

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Directions to “ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC ” Practice Location

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