Provider Demographics
NPI:1356457618
Name:MOTION SYNERGY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MOTION SYNERGY PHYSICAL THERAPY LLC
Other - Org Name:MSPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST , OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SHROPSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PT MSPT
Authorized Official - Phone:920-734-5150
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31500242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40427100Medicaid