Provider Demographics
NPI:1326008269
Name:SHROPSHIRE, MARK (PT, MSPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SHROPSHIRE
Suffix:
Gender:M
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-0524
Mailing Address - Country:US
Mailing Address - Phone:920-734-5150
Mailing Address - Fax:
Practice Address - Street 1:3600 N WINTERSET DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8552
Practice Address - Country:US
Practice Address - Phone:920-734-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3150024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40427100Medicaid
WI40427100Medicaid