Healthcare Provider Details

I. General information

NPI: 1740194802
Provider Name (Legal Business Name): DAVID J VANDERHEYDEN M.S., CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6571 RIDGEVIEW DR
CLARKSTON MI
48346-4453
US

IV. Provider business mailing address

6571 RIDGEVIEW DR
CLARKSTON MI
48346-4453
US

V. Phone/Fax

Practice location:
  • Phone: 248-762-6874
  • Fax:
Mailing address:
  • Phone: 248-762-6874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: