Organization
ADVANCE PHYSICAL THERAPY & SPORTS REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARREN S KO PT (OWNER)
(920) 356-0122
Entity
Organization
Contact information
Practice address
201 GATEWAY DR STE 300, BEAVER DAM, WI 53916-9176
(920) 356-0122
(920) 356-0470
Mailing address
PO BOX 775, BEAVER DAM, WI 53916-0775
(920) 356-0122
(920) 356-0470
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
9886024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100028270
—
WI
01
—
3182
MEDICARE PTAN
—
Enumeration date
07/10/2012
Last updated
07/21/2022
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