{
"Npi": {
"NPI": "1356457618",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MOTION SYNERGY PHYSICAL THERAPY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 524",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "APPLETON",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54912-0524",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-734-5150",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3600 N WINTERSET DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "APPLETON",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54911-8552",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-734-5150",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/21/2006",
"LastUpdateDate": "03/05/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHROPSHIRE",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "WILLIAM",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST , OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT MSPT",
"AuthorizedOfficialTelephoneNumber": "920-734-5150",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": "3150024",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}