Provider Demographics
NPI:1568867836
Name:PULSESPORTZ FOUNDATION
Entity Type:Organization
Organization Name:PULSESPORTZ FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-406-0501
Mailing Address - Street 1:818 FRIENDLY PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5800
Mailing Address - Country:US
Mailing Address - Phone:704-313-5167
Mailing Address - Fax:
Practice Address - Street 1:818 FRIENDLY PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5800
Practice Address - Country:US
Practice Address - Phone:704-313-5167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
No251F00000XAgenciesHome Infusion
No251K00000XAgenciesPublic Health or Welfare
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies