Healthcare Provider Details

I. General information

NPI: 1639005515
Provider Name (Legal Business Name): POULIN PERFORMANCE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SANDPIPER DR
WHISPERING PINES NC
28327-9323
US

IV. Provider business mailing address

18 SANDPIPER DR
WHISPERING PINES NC
28327-9323
US

V. Phone/Fax

Practice location:
  • Phone: 802-598-1264
  • Fax:
Mailing address:
  • Phone: 802-598-1264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER POULIN
Title or Position: OWNER
Credential: PT
Phone: 802-598-1264