NPIMap

Organization Active NPI

Advance Therapy Center, Inc

  • Physical Therapist
  • Fond Du Lac, WI
National Provider Identifier
1861601262
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3756-024 Issued in WI
Legal business name
ADVANCE THERAPY CENTER, INC
Practice address
976 E Johnson St
Ste. 100
Fond Du Lac, WI 54935-9746
Phone
(920) 322-9128
NPI assigned
May 22, 2007
Organization subpart
No

National Provider Directory

National Provider Directory

Locations

976 E Johnson St
Ste 100
Fond du Lac, WI 54935
Phone (920) 322-9128

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Karla J King
Title
Office Manager
Phone
(920) 233-7177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 3756-024 WI Primary

Addresses

Primary practice location

976 E Johnson St
Ste. 100
Fond Du Lac, WI 54935-9746

Mailing address

3475 Omro Rd
Ste. 300
Oshkosh, WI 54904-7125
Phone (920) 233-7177

Other identifiers 1

IdentifierTypeStateIssuer
41219900MedicaidWI

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861601262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 OMRO RD",
            "address_2": "STE. 300",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549047125",
            "telephone_number": "920-233-7177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "976 E JOHNSON ST",
            "address_2": "STE. 100",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549359746",
            "telephone_number": "920-322-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE THERAPY CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "KARLA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "920-233-7177"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "3756-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41219900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.