ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC — NPI 1407857790 (Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation in APPLETON, WI)

CMS-1500 Box 24J / 33a • NPI

1407857790

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

208100000X (CMS 25)

Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation

Box 32 Service Location & ZIP+4

2105 E ENTERPRISE AVE # 113, ADVANCED PHYSICAL THERAPY, APPLETON, WI, 54913-7862

✓ 9-Digit EDI 837 ZIP+4 (54913-7862)

Practice Phone & Referral Fax

(920) 991-2561

Fax: (920) 991-2563

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1407857790 (ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1407857790` (NPI-2 Organization / Facility)
Provider / Legal Name	ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation NUCC Code: `208100000X` (Physical Medicine & Rehabilitation)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2105 E ENTERPRISE AVE # 113, ADVANCED PHYSICAL THERAPY, APPLETON, WI, 54913-7862
Practice Telephone / Fax	Tel: (920) 991-2561 \| Fax: (920) 991-2563
Administrative Mailing Address	2105 E ENTERPRISE AVE STE 113, APPLETON, WI, 54913-7862
Enumeration & Last Sync	Enumerated: 2005-08-09 \| CMS Record Updated: 2026-03-10
Authorized Official	CAMILLA MEYER (Credentialing Specialist)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2105 E ENTERPRISE AVE # 113, ADVANCED PHYSICAL THERAPY, APPLETON, WI, 54913-7862

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Plain-English Taxonomy & CMS Crosswalk (208100000X)

What Does Taxonomy Code 208100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 208100000X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 25 (Physician/Physical Medicine and Rehabilitation)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physical Medicine & Rehabilitation for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`332B00000X` — Durable Medical Equipment & Medical Supplies Plain English: Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies	State: N/A \| License: `Verified` \| Primary: Secondary
`261QP2000X` — Clinic/Center, Physical Therapy Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`208100000X` — Physical Medicine & Rehabilitation Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ADVANCED PHYSICAL THERAPY & SPORTS MEDICINE SC (NPI #1407857790)