=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700746377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALT OF THE EARTH SPA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2025
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 N MADISON AVE STE F
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46142-4049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-628-5954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4698 E 500 N
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46131-8720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-628-5954
-----------------------------------------------------
Fax | 317-628-5954
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TYA SAGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-628-5954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------