OrganizationActive
Advance Physical Therapy and Sports Rehab, LLC
NPI 1780022525 · Physical Therapy Clinic/Center · Beaver Dam, WI
Provider details
- NPI number
- 1780022525
- Entity type
- Organization
- Primary specialty
- Physical Therapy Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Jim Ko, Business Manager(920) 356-0122
- License
- 12384-24 (WI)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(77/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1626 N Spring St Ste B
Beaver Dam, WI 53916-1283
Phone: (920) 356-0122
Street-level locationGet directions
Mailing address
Po Box 775
Beaver Dam, WI 53916-0775
Registry dates
- Enumerated
- 2013-06-13
- Last updated
- 2013-06-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.