Alexander Shutter, DPT

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

1745324 Issued in WI

Practice address

1772 Riverside Dr
Suamico, WI 54173-8100

Phone

(920) 838-5483

NPI assigned

Aug 23, 2025

Sex

Unspecified or another gender identity

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 23, 2025.

{
    "created_epoch": "1755907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755907200000",
    "number": "1699653170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1772 RIVERSIDE DR",
            "city": "SUAMICO",
            "state": "WI",
            "postal_code": "541738100",
            "telephone_number": "920-838-5483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1772 RIVERSIDE DR",
            "city": "SUAMICO",
            "state": "WI",
            "postal_code": "541738100",
            "telephone_number": "920-838-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUTTER",
        "first_name": "ALEXANDER",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "X",
        "enumeration_date": "2025-08-23",
        "last_updated": "2025-08-23",
        "certification_date": "2025-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "WI",
            "license": "1745324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Suamico, WI
• Sports Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.