Individual provider Active NPI

Andrew J Taber, PT

  • Physical Therapist
  • Green Bay, WI
National Provider Identifier
1457336992
Registry record updated Jul 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10026 Issued in WI
Practice address
2223 Lime Kiln Rd
Green Bay, WI 54311-6213
Phone
(920) 560-1147
Fax
(920) 560-1197
NPI assigned
Dec 7, 2005
Last updated
Jul 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10026 WI Primary

Addresses

Primary practice location

2223 Lime Kiln Rd
Green Bay, WI 54311-6213

Mailing address

2105 E Enterprise Ave Ste 113
Appleton, WI 54913-7862
Phone (920) 560-1147

Other practice location 1

1200 Flightway Dr
Hobart, WI 54115-9301
Phone (920) 425-7140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040610000810 WI Practitioner - Physical Therapist in Private Practice 6305829367 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2223 Lime Kiln Rd
Green Bay, WI 54311-6213
Phone (920) 965-4715

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10026WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Physical Therapy & Sports Medicine SC Physical Therapist CurrentSince Apr 1, 2011 Accepting new patients
Advanced Physical Therapy & Sports Medicine SC Physical Therapist CurrentSince Apr 1, 2011 Accepting new patients

Locations

2105 E Enterprise Ave
Appleton, WI 54913
Phone (920) 560-1000

2105 E Enterprise Ave
Ste 113
Appleton, WI 54913
Phone (920) 560-1083

2223 Lime Kiln Rd
Green Bay, WI 54311
Phone (920) 430-4770

1200 Flightway Dr
Hobart, WI 54115
Phone (920) 425-7140

1370 N Shawano St
Ste E
New London, WI 54961
Phone (920) 249-7171

212 E Green Bay St
Shawano, WI 54166
Phone (715) 526-5221

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752192000000",
    "number": "1457336992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 E ENTERPRISE AVE STE 113",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137862",
            "telephone_number": "920-560-1147",
            "fax_number": "920-560-1197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 LIME KILN RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116213",
            "telephone_number": "920-560-1147",
            "fax_number": "920-560-1197"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 Flightway Dr",
            "address_purpose": "LOCATION",
            "city": "Hobart",
            "state": "WI",
            "postal_code": "541159301",
            "country_code": "US",
            "telephone_number": "920-425-7140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TABER",
        "first_name": "ANDREW",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2025-07-11",
        "certification_date": "2025-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.