Organization
ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC
Active
Organization
ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMILLA MEYER (CREDENTIALING SPECIALIST)
(920) 393-2819
Entity
Organization
Contact information
Practice address
5000 W CHAMPION DR, GRAND CHUTE, WI 54913-5000
(920) 560-1123
(920) 202-3535
Mailing address
2105 E ENTERPRISE AVE STE 113, APPLETON, WI 54913-7862
(920) 991-2561
(920) 991-2563
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/03/2023
Last updated
03/10/2026
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