Provider Demographics
NPI:1598186082
Name:SANDHILLS SPORTS PERFORMANCE
Entity Type:Organization
Organization Name:SANDHILLS SPORTS PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:910-420-1419
Mailing Address - Street 1:5 GLEN ROSS DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-7053
Mailing Address - Country:US
Mailing Address - Phone:910-603-2788
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13681261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy