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General NPI Number Information
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NPI Number | 1619787959
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Entity Type | Organization
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Legal Business Name | SHORELINE SPORT & SPINE PLLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 2073 HOLTON RD
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City | MUSKEGON
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State | MI
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Zip | 49445-1535
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Country | US
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Telephone | 231-744-0077
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Fax | 616-847-1290
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Provider Business Mailing Address
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Address Line | 18000 COVE ST STE 202
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City | SPRING LAKE
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State | MI
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Zip | 49456-1383
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Country | US
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Telephone | 616-847-1280
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Fax | 616-847-1290
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Authorized Official
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Title or Position | CEO
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Name | MARTIN J SYTSEMA
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Credential |
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Telephone | 616-847-1280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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