Provider Demographics
NPI:1417663675
Name:LOTUS TRANSFORMATIONS, LLC
Entity Type:Organization
Organization Name:LOTUS TRANSFORMATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:208-301-8557
Mailing Address - Street 1:619 S WASHINGTON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3063
Mailing Address - Country:US
Mailing Address - Phone:208-301-8557
Mailing Address - Fax:208-882-6866
Practice Address - Street 1:619 S WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3063
Practice Address - Country:US
Practice Address - Phone:208-301-8557
Practice Address - Fax:208-882-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1326689783OtherREGENCE
ID1346689783OtherREGENCE