MEDICARE: THE KULTURE SPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1710732904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KULTURE SPA

Provider Business Mailing Address
First Line	:	1788 HERITAGE CENTER DR STE 202
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3972
Country	:	US
Telephone Number	:	919-656-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1788 HERITAGE CENTER DR STE 202
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-3972
Country	:	US
Telephone Number	:	919-656-1088
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOVHANNAH TISDALE
Credential	:	LMBT
Telephone Number	:	919-656-1088

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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Directions to “THE KULTURE SPA ” Practice Location

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