Provider Demographics
NPI:1144632118
Name:SANDHILLS SPORTS PERFORMANCE
Entity type:Organization
Organization Name:SANDHILLS SPORTS PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:POULIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-603-2788
Mailing Address - Street 1:295 PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7051
Mailing Address - Country:US
Mailing Address - Phone:910-603-2788
Mailing Address - Fax:888-452-5964
Practice Address - Street 1:295 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7051
Practice Address - Country:US
Practice Address - Phone:910-603-2788
Practice Address - Fax:888-452-5964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty