Individual
ANDREW J TABER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2223 LIME KILN RD, GREEN BAY, WI 54311-6213
(920) 560-1147
(920) 560-1197
Mailing address
2105 E ENTERPRISE AVE STE 113, APPLETON, WI 54913-7862
(920) 560-1147
(920) 560-1197
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10026-024
LICENSE
WI
Enumeration date
12/07/2005
Last updated
07/11/2025
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