Healthcare Provider Details

I. General information

NPI: 1619787959
Provider Name (Legal Business Name): SHORELINE SPORT & SPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 HOLTON RD
MUSKEGON MI
49445-1535
US

IV. Provider business mailing address

18000 COVE ST STE 202
SPRING LAKE MI
49456-1383
US

V. Phone/Fax

Practice location:
  • Phone: 231-744-0077
  • Fax: 616-847-1290
Mailing address:
  • Phone: 616-847-1280
  • Fax: 616-847-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARTIN J SYTSEMA
Title or Position: CEO
Credential:
Phone: 616-847-1280