Provider Demographics
NPI:1184226490
Name:LIFESTYLE TRANSITIONS, PLLC
Entity Type:Organization
Organization Name:LIFESTYLE TRANSITIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:817-891-3255
Mailing Address - Street 1:9328 WOOD DUCK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-7784
Mailing Address - Country:US
Mailing Address - Phone:682-253-2366
Mailing Address - Fax:817-537-2510
Practice Address - Street 1:9328 WOOD DUCK DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-7784
Practice Address - Country:US
Practice Address - Phone:817-891-3255
Practice Address - Fax:682-253-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty