Healthcare Provider Details

I. General information

NPI: 1326576794
Provider Name (Legal Business Name): MOTUS RX PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W5361 COUNTY ROAD KK STE E
APPLETON WI
54915-7271
US

IV. Provider business mailing address

W5361 COUNTY ROAD KK STE E
APPLETON WI
54915-7271
US

V. Phone/Fax

Practice location:
  • Phone: 920-540-2344
  • Fax: 920-779-1460
Mailing address:
  • Phone: 920-540-2344
  • Fax: 920-779-1460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number11251-24
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number11251-24
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11251-24
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11251-24
License Number StateWI

VIII. Authorized Official

Name: DR. ERIC T WALLACE
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 920-540-2344