| Organization Name: | SHORELINE SPORT & SPINE PC |
| NPI Number: | 1225040694 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID C. VANANDEL (CEO) |
| Mailing Address: | 18000 Cove Street Suite 202 Spring Lake |
| State: | MI US |
| Postal Code: | 49456 |
| Phone Number: | 6168471280 |
| Fax Number: | 6168471290 |
| NPI Enumeration Date: | 08/13/2006 |
| NPI Last Update Date: | 12/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |