Basic Information
| Provider Information | |||||||||
| NPI: | 1144632118 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANDHILLS SPORTS PERFORMANCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 295 PINEHURST AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283877051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106032788 | ||||||||
| FaxNumber: | 8884525964 | ||||||||
| Practice Location | |||||||||
| Address1: | 295 PINEHURST AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283877051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106032788 | ||||||||
| FaxNumber: | 8884525964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2014 | ||||||||
| LastUpdateDate: | 05/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | POULIN | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9106032788 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9500 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.