Healthcare Provider Details

I. General information

NPI: 1194669143
Provider Name (Legal Business Name): CULTIVATE PHYSICAL THERAPY & PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 L ST
NORTH WILKESBORO NC
28659-3819
US

IV. Provider business mailing address

PO BOX 261
NORTH WILKESBORO NC
28659-0261
US

V. Phone/Fax

Practice location:
  • Phone: 828-358-8010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILLIAM FRANKLIN ALEXANDER HOLLAND
Title or Position: OWNER
Credential: PT, DPT
Phone: 828-358-8010