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
2223 LIME KILN RD, GREEN BAY, WI 54311-6213
(920) 965-4715
(920) 569-1520
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41174800
—
WI
Enumeration date
05/08/2018
Last updated
03/10/2026
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