Organization
ADVANCE PHYSICAL THERAPY AND SPORTS REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM KO (BUSINESS MANAGER)
(920) 356-0122
Entity
Organization
Contact information
Practice address
1626 N SPRING ST STE B, BEAVER DAM, WI 53916-1283
(920) 356-0122
Mailing address
PO BOX 775, BEAVER DAM, WI 53916-0775
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
12384-24
WI
Other
Enumeration date
06/13/2013
Last updated
06/13/2013
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