# ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407857790
- **Authorized official:** CAMILLA MEYER (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (920) 393-2819

## Contact information

- **Practice address:** 2105 E ENTERPRISE AVE \# 113, ADVANCED PHYSICAL THERAPY, APPLETON, WI 54913-7862
- **Practice address phone:** (920) 991-2561
- **Practice address fax:** (920) 991-2563
- **Mailing address:** 2105 E ENTERPRISE AVE STE 113, APPLETON, WI 54913-7862
- **Mailing address phone:** (920) 991-2561
- **Mailing address fax:** (920) 991-2563

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 08/09/2005
- **Last updated:** 03/10/2026